HASMATE - Break Out Audit

• Client / Site - where audit undertaken

• Conducted on

  Date

• Prepared by

• Location / Address
  Address

• Employee / Breaker Out

Items

• Is the Breaker Out wearing all required protective equipment?

  Yes

  No

• Is the break out planned before return to strops?

  Yes

  No

• Does the Breaker Out stand clear of moving ropes?

  Yes

  No

• Have clear communication/signals been agreed with the extraction machine operator?

  Yes

  No

• Is the strop position on logs OK (near end of logs)?

  Yes

  No

• Are logs securely stropped (none falling off)?

  Yes

  No

• Does the Breaker Out move to a safe retreat position before winch-in begins?

  Yes

  No

• Were there any log breakages?

  Yes

  No

  N/A

• General comments about audit

Corrective Actions

• Corrective Actions Required

Action Required

• What corrective action is required?

Audit Sign Off

• Sign Off

Employee

• Signature

  Sign

• Job Title