Heavy Vehicle Pre-Site Entry Safety Inspection

• Anagold Contract or Equipment Owner/Responsible Department

  Select OPERATIONAL PROJECTS dept SULFIDE PROJECT dept EXPLORATION & DRILLING dept GEOLOGY dept MINING dept ADMINISTRATION dept PROCESS dept MAINTENANCE dept WAREHOUSE & SUPPLY dept COMMUNITY RELATIONS dept

  • OPERATIONAL PROJECTS dept
  • SULFIDE PROJECT dept
  • EXPLORATION & DRILLING dept
  • GEOLOGY dept
  • MINING dept
  • ADMINISTRATION dept
  • PROCESS dept
  • MAINTENANCE dept
  • WAREHOUSE & SUPPLY dept
  • COMMUNITY RELATIONS dept

• Anagold Contract or Owner Responsible Persons Name

• Truck Driver Name:

• Truck Driver's Company Name

• Inspection Started Date and Time

  Date

• Anagold Inspecting Mechanics Name:

• Vehicle Year, Make, Model.

• VIN Number

TRUCK DESCRIPTION

• Description of the Truck Type

• Indicate the Truck Type

  Select Hiab Truck Water Transport Truck Fuel or Oil Transport Truck Flat Bed Truck Haulage Tip Truck Semi Trailer Truck with Trailer Drill Rig Truck

  • Hiab Truck
  • Water Transport Truck
  • Fuel or Oil Transport Truck
  • Flat Bed Truck
  • Haulage Tip Truck
  • Semi Trailer Truck with Trailer
  • Drill Rig Truck

• Indicate the Truck Load Capacity

  Select 0 - 2 ton 2 - 4 ton 4 - 6 ton 6 - 10 ton 10 - 12 ton 12 - 18 ton 18 - 24ton 24 - Greater

  • 0 - 2 ton
  • 2 - 4 ton
  • 4 - 6 ton
  • 6 - 10 ton
  • 10 - 12 ton
  • 12 - 18 ton
  • 18 - 24ton
  • 24 - Greater

• Other Information about the Truck

• Photograph of the Truck showing the full side view

  Media

ADMINISTRATIVE

• Is the Vehicle Registration Papers Current and Confirm it is the Correct Truck?

  Yes

  No

  N/A

• Photograph the Vehicle Registration Papers

  Media

• Does the VIN number on the licence papers match the VIN number on the Truck?

  Yes

  No

  N/A

• How many people is this Truck licensed to carry in the operator's cabin?

  1 Person

  2 People

  3 People

  4 People

  5 People

• Is License plate and tags current and Match the license number on the Registration Papers?

  Yes

  No

  N/A

• Photograph the Number Plate

  Media

• Is the Vehicle/Truck Insured? Photograph the Papers

  Yes

  No

  N/A

• Photograph the Insurance Papers

  Media

SAFETY & PROJECT MANAGEMENT

• Is there an Anagold Health & Safety Manual in the truck?

  Yes

  No

  N/A

• Is there a First Aid Kit and is it complete with items/contents within the expiration date?

  Yes

  No

  N/A

• Is there a Fire extinguisher mounted with inspection tag date at within 6 months?

  Yes

  No

  N/A

• Does the operator have the Anagold minimum required PPE needed for entry into the mine site and process areas?

  Yes

  No

  N/A

INTERIOR OF VEHICLE

• Is the Interior clean of trash and dirt?

  Yes

  No

  N/A

• Is there seat a belt available for the Truck operator?

  Yes

  No

  N/A

• Is the seat belt in good working condition and has no damage to the belt material and the buckle/latch is working correctly?

  Safe

  At Risk

  N/A

• Is there seat a belt available for each of the total number of passengers the truck is licensed to carry? (e.g. Licensed to carry 4 personnel - must have 4 seat belts)

  Yes

  No

  N/A

• Are all the seat belts in good working condition and have no damage to the belt material with the buckle/latches fully functional?

  Safe

  At Risk

  N/A

• Are the Instrument panels indicating and all working properly? (e.g. Speedometer, RPM, Fuel Level Gauge)

  Yes

  No

  N/A

• Is the Windshield, rear view mirror and side mirrors clean and free from cracks?

  Yes

  No

  N/A

• Please provide a photo of the interior.

  Media

EXTERIOR & MECHANICAL

• What was the date of last service?

• Are the Reversing lights Working?

  Safe

  At Risk

  N/A

• Is all fan Belts & radiator Hoses in good operational condition?

  Safe

  At Risk

  N/A

• Are the Brakes Working correctly? ( test the Brake Pedal Pressure)

  Safe

  At Risk

  N/A

• Is the Hand Brake Working correctly and is it adjusted so that the truck cannot drive if the brake is engaged? ( test the Hand Brake with the truck in gear and release the clutch)

  Safe

  At Risk

  N/A

• Check all the Fluid Levels?

  Safe

  At Risk

  N/A

• Select the box that describes the condition correctly

  Select Engine Oil Level Correct Engine Oil Level Low Engine Oil to be Topped Up Brake Fluid level Correct Brake Fluid Level Low Clutch Fluid Level Correct Clutch Fluid Level Low Radiator Bottle Level Good Radiator Bottle Level Low

  • Engine Oil Level Correct
  • Engine Oil Level Low
  • Engine Oil to be Topped Up
  • Brake Fluid level Correct
  • Brake Fluid Level Low
  • Clutch Fluid Level Correct
  • Clutch Fluid Level Low
  • Radiator Bottle Level Good
  • Radiator Bottle Level Low

• Are there any Visible Fluid Leaks?

  Safe

  At Risk

  N/A

• Do all Emergency Flashers Work Correctly?

  Safe

  At Risk

  N/A

• Do the Headlights work Correctly in Low Beam and High Beam?

  Safe

  At Risk

  N/A

• Are the Tail Lights all Working Correctly?

  Safe

  At Risk

  N/A

• Select Red Tail Lights Good Red Tail Lights Fault Red Braking Lights Good Red Braking Lights Fault Left & Right Turning Lights Good Left & Right Turning Lights Fault

  • Red Tail Lights Good
  • Red Tail Lights Fault
  • Red Braking Lights Good
  • Red Braking Lights Fault
  • Left & Right Turning Lights Good
  • Left & Right Turning Lights Fault

• Is the Rotating Beacon installed and working correctly?

  Safe

  At Risk

  N/A

• Are the Turn Signals Working Correctly and Cancel when the turn is completed?

  Safe

  At Risk

  N/A

• Does the Horn Work Correctly?

  Safe

  At Risk

  N/A

• Is the Steering & Alignment in good operating condition?

  Safe

  At Risk

  N/A

• Check the Operation of the Windshield Wiper Blades?

  Safe

  At Risk

  N/A

• Is the Window Wiper Washer Working Correctly?

  Safe

  At Risk

  N/A

• Comments:

CARGO & EQUIPMENT

• Is all equipment is secured and stored correctly?

  Safe

  At Risk

  N/A

• Is the truck is organized and free of excessive or loose tooling and/or materials?

  Safe

  At Risk

  N/A

• Is the truck is organized and free of excessive or loose tooling and/or materials?

  Safe

  At Risk

  N/A

• Is there tie down chains and slings for securing loads?

  Safe

  At Risk

  N/A

• Is the tie down equipment in good operating condition?

  Safe

  At Risk

  N/A

• Does the truck have proper storage locker for hand tools, tie down shackles, chains and turnbuckles?

  Safe

  At Risk

  N/A

• If the Truck is a Tanker Transporter please select the type of Liquids it is used to carry

  Select Water Dry Cement Powder Wet Cement Dry Lime Powder Hazardous Chemicals Diesel Fuel Petroleum

  • Water
  • Dry Cement Powder
  • Wet Cement
  • Dry Lime Powder
  • Hazardous Chemicals
  • Diesel Fuel
  • Petroleum

• If the Truck is a Liquid Transport Tanker then Check the Tank Body and confirm the last test for cracks was completed in the last 12 months

  Safe

  At Risk

  N/A

• Is there a VARMI Control Test Certificate required for the tank?

  Yes

  No

  N/A

• Is there Chemical indicating VARMI warning signs and labels?

  Yes

  No

  N/A

• Are all pipe connections and valves correctly fixed or locked as required

  Yes

  No

  N/A

• Is there a chemical MSDS available for the type of chemicals transported in this tanker?

  Yes

  No

  N/A

• Call responsible department and have them check the Truck has the correct permits for the Chemicals or liquids it is transporting?

  Yes

  No

  N/A

PLEASE PROVIDE PHOTOS

• Driver's Side

  Media

• Passenger's Side

  Media

• Bed of truck

  Media

ANSWER IF THE TRUCK IS A FIXED CHASSIS WITH NO TRAILER

• Check Brakes if equipped?

  Yes

  No

  N/A

• Is all the Cargo or the Tanker or the Dump Tray Secure?

  Yes

  No

  N/A

• Do all Lights/Night Marker Lamps work properly?

  Yes

  No

  N/A

• Are all Straps/Tie Downs in good operating condition?

  Yes

  No

  N/A

• Do the Suspension Springs Appear OK?

  Yes

  No

  N/A

• Check the Tires & Pressure and record whether they are all even and correct pressure for the type of tyre?

  Yes

  No

  N/A

• Check all wheel rims and wheel nuts for correct installation and report?

  Safe

  At Risk

  N/A

IF EQUIPPED WITH A TRAILER

• Has the Trailer has been checked for proper connection to the vehicle?

  Safe

  At Risk

  N/A

• Check Brakes if equipped?

  Yes

  No

  N/A

• Is all the Cargo Secure?

  Yes

  No

  N/A

• Do all Lights/Marker Lamps work properly?

  Yes

  No

  N/A

• Do the Suspension Springs Appear OK?

  Yes

  No

  N/A

• Are all Straps/Tie Downs in good operating condition?

  Yes

  No

  N/A

• Check the Trailer Tires & Pressure and record whether they are all even and correct pressure for the type of tyre?

  Yes

  No

  N/A

• Check all wheel rims and wheel nuts for correct installation and report?

  Safe

  At Risk

  N/A

Print Name and Signature of Person Inspecting the Equipment

• Tick the box that is applicable (NOTE: Inspecting mechanic cannot authorize the issuing of the Site Entry Label/Sticker)

  Select INSPECTION PASSED INSPECTION FAILED

  • INSPECTION PASSED
  • INSPECTION FAILED

• I declare that I have inspected this equipment and to the best of my knowledge the detail in my report is true and meets the Anagold Safety Standards and the Turkish Mobile Equipment regulations

  Sign

• Your Job Description

  Select Mechanic Mobile Equipment Plant Mechanic Mobile Equipment Operator Process Plant Operator Maintenance Team Leader Process Team Leader

  • Mechanic Mobile Equipment
  • Plant Mechanic
  • Mobile Equipment Operator
  • Process Plant Operator
  • Maintenance Team Leader
  • Process Team Leader

Print Name of Maintenance Supervisor Reviewing this Inspection and Authorizing the Issuance of the Site Entry Sticker

• Tick the box that is applicable (NOTE: Maintenance Supervisor cannot authorize the issuing of the Site Entry Label/Sticker)

  Select INSPECTION PASSED INSPECTION FAILED

  • INSPECTION PASSED
  • INSPECTION FAILED

• I declare that I have reviewed this inspection and I am satisfied the detail in the report meets the Anagold Safety Standards and the Turkish Mobile Equipment regulations and the inspection has been completed to meet the ISO 55000 standards

  Sign

• Your Job Description

  Select Mechanical Supervisor ADR Mechanical Supervisor Crusher Maintenance Planner

  • Mechanical Supervisor ADR
  • Mechanical Supervisor Crusher
  • Maintenance Planner

Print Name and Signature of Chief Authorizing the Issuance of the Vehicle Site Entry Sticker

• NOTE: Only the Maintenance Department Chief or his delegate can give authorization to issue the Anagold Site Entry Label/Sticker. In the absence of the Maintenance Department Chief or if there is a clear conflict of interest where a person completing the equipment safety inspection is related to the equipment owner, then the Maintenance Department Manager will sign off on the authority to issue the site entry label/sticker.

• Tick the box that is applicable

  Select ISSUE SITE ENTRY STICKER Inspection to be Revised - HOLD DO NOT ISSUE SITE ENTRY STICKER

  • ISSUE SITE ENTRY STICKER
  • Inspection to be Revised - HOLD
  • DO NOT ISSUE SITE ENTRY STICKER

• I declare I have reviewed this inspection and am satisfied that the Truck condition meets Anagold Safety and Operational standards.

  Sign

• Your Job Description

  Select Mechanical Maintenance Chief Electrical Maintenance Chief Maintenance Planning Chief

  • Mechanical Maintenance Chief
  • Electrical Maintenance Chief
  • Maintenance Planning Chief