Information

  • Document No.

  • Task

  • Job No./ Site Address

  • Conducted on

  • Prepared by

Internal Assessment

Pre-operational checklist & logbook Jcb Excavator

  • Operator name

  • Machine hours

  • Make & model check<br>Kubota KX41-3V<br>

Equipment Assessment

Fluids

  • Engine oil ok?

  • Engine oil ok

  • Transmission oil ok

  • Coolant level ok

  • Fuel level ok

  • Any visually seen leaks or signs of cracking/rust

Site Assessment

External inspection

  • Fire extinguisher present & full

  • All lights & reflectors are in good working order

  • Amber beacon available

  • OPG ( operator protective guard ) present, sturdily attached and free of damage

  • All hydraulic hoses are connected properly & free from leaks & damage ( never use your hand for leaks, always use wood or cardboard )

  • All tracks & track components are in safe working condition

  • Bucket Locking pin, check if pin is free from damage & surclip is functioning properly

  • Check all structural components are in safe working condition

Operator work area

  • Operator floor non slip & free from damage

  • All operator access non-slip, sturdily attached & free from damage with three points of contact

  • Seat, attached & free from damage

  • Seat belt present, sturdily attached & free from damage

  • Two exits available<br>

  • All controls are fully functional & clearly & legibly labelled as to purpose & method of operation

  • Operator warning device functional ( horn )

  • Movement awareness alarm present & fully functional

  • Any site obstacles present (eg: power lines, temporary fencing )

  • Load chart present & legible

Machine function & information

  • Machine functions as per manufacturers operating instruction & all manufacturers operational & safety information is available

Worker Consulation

Witness if workers are on site whilst machine is in operation

    Worker
  • I the undersigned have been consulted in relation to the pre-operational checklist & logbook and have been advised of all safety awareness whilst machine is in use

  • Sign off

Sign Off

  • Have you eliminated all potential risks from any other hazards identified on site that may affect your work tasks?

  • Contact Shaun White prior to proceeding

  • Signature of person completing this assessment

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.