Title Page
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Conducted on
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Prepared by
Haul truck
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Haul truck #
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Make and Model
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Name of operator
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years of experience on job
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Was break test done ?
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Are there any devices that could distract or impair the the operator (cell phones, ear buds, headphones)
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is horn functioning?
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are windows clean and no obstructions in operators line of sight?
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does Truck have a back up camera and is it functioning?
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is back up alarm functioning ?
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Is radio functioning radio check?
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are lights all functioning?
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Are all mirrors in place and adjusted properly?
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What is the procedure for a pedestrian to enter the ore pad? (Answer: contact the operator by radio)
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What must the operator do before moving forward and before backing up? (Answer: sound the horn once for forward and twice for backing up)
Loader
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Loader #
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Make and model
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Name of operator
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years of experience on job
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Was break test done ?
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Is the horn functioning?
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Is the Back up alarm functioning?
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Is radio functioning radio check?
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Are the windows clean and no obstruction of operator line of sight?
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Are lights all functioning and clean?
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is there a back up camera and is it functioning?
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Are all mirrors in good condition and clean?
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Are there any devices that could distract or impair the the operator (cell phones, ear buds, headphones)
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What is the procedure for a pedestrian to enter the ore pad? (Answer: contact the operator by radio)
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What must the operator do before moving forward and before backing up? (Answer: sound the horn once for forward and twice for backing up)
Pedestrian
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Name of pedestrian
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Job description
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Work experience
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location of pedestrian
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What is the procedure for a pedestrian to enter an area where mobile equipment is operating? (Answer: contact the operator by radio. Wait for operator permission to enter the area and the operator to park the equipment and lower any implements).
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Pedestrian’s HVSA apparel in good condition? Class 3 HVSA? Reflective materials are clearly visible?
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If you hear a horn sound twice from a vehicle or mobile equipment unit what is the operator going to do? (Answer: reverse the unit)
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Reflective stripes on hardhat? Clean and not covered by obstructions such as decals and stickers.
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Does the pedestrian have a good general knowledge of blind spots for the vehicles or mobile equipment they will encounter?
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Where are the safest locations for pedestrians to walk at the bunkhouse, office parking lot and the Security Gatehouse? (Answer: designated pedestrian walkways and crossings)
Light vehicle
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unit #
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Make and Model
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is horn functioning?
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Is the Back up alarm functioning?
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Was break test done ?
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Are the windows clean and no obstruction of operator line of sight?
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Is radio functioning radio check?
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Are lights all functioning and clean?
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Are all mirrors in good condition and clean?
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Light VehicleOperator Name
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Are there any devices that could distract or impair the the operator (cell phones, ear buds, headphones)
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What must the operator do before moving forward and before backing up? (Answer: sound the horn once for forward and twice for backing up)
Bus
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Bus Unit No.
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Bus Make and Model
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Horn function
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Back-up alarm function
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Brake test
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Windows clean and no obstructions to operator line of sight
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Radio test
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Lights
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Does the bus have a back-up camera? If so, is it functioning.
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Mirrors in good condition and clean?
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Bus Operator Name
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Years of operating experience
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Can the bus stop at locations other than the designated stops to pick up or drop off passengers? (Answer: No)
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What must the operator do at every stop to pick up or drop off passengers?(Answer: Turn on the red flashing warning lights)
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What is the maximum speed limit in parking lots and congested areas? (Answer: 10 km/h)
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What must the operator do before moving forward and before backing up? (Answer: sound the horn once for forward and twice for backing up)
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Where can drivers operate the bus? (Answer: The established route will be the only place the drivers will be allowed to drive the bus.)
