Title Page
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Job Number
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Conducted on
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Customer Reference
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Asset No. + ID plates (+ Registration)
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Current Hours
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Location
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Inspected by
- A.Salter
- A.Kowarzik
- B.Slocombe
- L.Sant
- J.Georgiadis
- P.Pearce
- W.Kaiyum
- Other
- J.Alexander
- D.Short
- C.Rodwell
- A.Tanner
Pre-Start Safety Card
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Is a Pre-Start Safety Card Required?
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Are there any adjacent activities that may Impact on safety in the work zone?
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Please list the Hazard and the Control for the Activity.
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Does the Task involve any Safety Essentials? (If so Review and understand the Safety Essential.)
- No
- Electrical Work
- Mobile cranes and lifting operations
- Working at Heights
- Working with Live Services
- Working near Live Traffic
- Working in and around Mobile Plant
- Working with Temporary Works
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Does the task deal with Stored energy types?
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Please list the Stored energy type and the controls in place to deal with the energy.
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Does the task deal with any other hazards that are not addressed in the SWMS or Work instruction? (E.G. Inclement weather, slippery or unstable surfaces, chemicals, crush points, etc.)
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Please list the Hazard and the control for the hazard.
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Is there additional PPE required for this task?
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Please list extra PPE required
Information & Sign Off
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Report Details
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Is the Machine Safe for use?
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Technician Sign Off
