Information

  • Document No.

  • Task

  • Job No./ Site Address

  • Conducted on

  • Prepared by

Internal Assessment

Pre-operational checklist & logbook Case Excavator

  • Operator name

  • Machine hours

  • Make & model check<br>CASE CX145C Serial# 100340

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 changing pin, check if pin is free from cracking or damage & also surclip is in good working order

  • 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

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