Information

  • Document No.

  • Plant Number.

  • Contract and Plant Number

  • Conducted on

  • Assessor

  • Location
  • Hours of machine

  • Fuel Usage

Check Items

  • Is there panel damage (dents, scratches)?

  • Is there damage to glass or mirrors?

  • Is there damage to lights or safety beacon?

  • Are Guards damaged or out of place?

  • Have all buckets been returned and are they in good order (including teeth)

  • Are all hydraulic hoses OK?

  • Is the safety pin with the machine?

  • Are tyres/ tracks/ rollers OK?

  • Have grease gun and/ or tools been returned with machine?

  • Is radios & UHF in machine?

  • Are aerials OK?

  • Is operators manual with machine?<br>

  • Has plant book been returned with machine?

  • Has fire extinguisher been returned with machine?

  • Is machine clean?

Damages if any

  • Customer name

  • Brief description of issues if any

  • Action Required

  • Authorized Sign Off:

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.