MCC DUMP TRUCK ASSESSMENT

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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  Address

• Select date

  Date

Truck Number

Make and Model

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  Media

EQUIPMENT INSPECTION

• Is the proper PPE in the equipment to ensure compliance with MSHA standards ( hard hat, safety glasses and hi viz vest)

  Yes

  No

  N/A

• Operator checks radio to ensure proper communication with loaders and other equipment

  Yes

  No

  N/A

• Checks horn

  Yes

  No

  N/A

• Checks dump box hinges

  Yes

  No

  N/A

• Checks gate clamps

  Yes

  No

  N/A

• Checks gate pins

  Yes

  No

  N/A

• Check fluids

  Yes

  No

  N/A

• Checks tires

  Yes

  No

  N/A

• Checks for leaks

  Yes

  No

  N/A

• Checks windshield and mirrors

  Yes

  No

  N/A

• Inspects operational controls

  Yes

  No

  N/A

• Checks all lights

  Yes

  No

  N/A

• Checks backup alarm

  Yes

  No

  N/A

• Checks steering

  Yes

  No

  N/A

• Tests for proper brake function

  Yes

  No

  N/A

• Tests air brake

  Yes

  No

  N/A

• Tests accelerator function

  Yes

  No

  N/A

EQUIPMENT OPERATION

• Operator stays in the cab of the equipment while being loaded

  Yes

  No

  N/A

• Operator disengages the PTO while in motion

  Yes

  No

  N/A

• Operator uses mirrors when in travel and backing

  Yes

  No

  N/A

• Operator understands all the controls and their functions

  Yes

  No

  N/A

• Operator follows all posted speed limits

  Yes

  No

  N/A

• Operator follows traffic patterns

  Yes

  No

  N/A

• Operator applies proper shifting techniques

  Yes

  No

  N/A

• Operator understands the purpose of berms and proper dumping procedure

  Yes

  No

  N/A

• Operator understands to yield the right of way to loaded equipment

  Yes

  No

  N/A

• Operator inspects dumping site for hazards before dumping

  Yes

  No

  N/A

• Operator checks to make sure gate clamps are engaged after dumping and before driving away

  Yes

  No

  N/A

• Operator dumps in a slow and safe manner

  Yes

  No

  N/A

FINAL ASSESSMENT

• Is the operator competent to operate the equipment listed above

  Yes

  No

  N/A

• Does he/she operate the equipment in a safe manner according to MSHA, OSHA and MCC standards

  Yes

  No

  N/A

ASSESSOR

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COMPETENT PARTY

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