Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Add location
  • Select date

NAME OF EMPLOYEE BEING ASSESSED

  • Make/Model of machine:

Hazard identification

  • Makes an assessment of the area ?

  • What action must be taken if you identify a hazard in your workplace ?

  • Develop a plan of how the task is to be completed ? JSA

Control hazards

  • Take appropriate measures to safeguard personnel and machinery ?

Pre-Start inspection

  • Check for "Out of Service" and "Personal Danger Tags"

  • Visually check underneath machine for any leaks

  • Check condition of tires

  • Check handrails/steps for damage and cleanliness

  • Check wheel nuts are not missing and are not loose

  • Pivot pins are secure and retaining plates/bolts are present

  • Checks hydraulic oil level

  • Check grease lines and nipples for damage

  • Checks all lift cylinders for damage and leakage

  • Checks the bucket condition

  • Check fire extinguisher date and charge

Boarding procedure

  • Maintains three points of contact, facing the machine

  • Makes sure doors are secured

Operators compartment

  • Adjusts seat/mirrors and fit seat belt

  • Correctly identify all controls and state their function

  • Ensures hazard warning lights are functioning correctly

Starting the engine

  • Ensures parking brake is applied

  • Ensure all implement controls are in neutral

  • Check transmission is in neutral

  • Turn ignition on and test the instrument panel

  • Use correct horn signal for start up

  • Start the engine

  • Allow engine to idle and check for warning signals

Control function test

  • Check bucket, lift and dump operation

  • Test park brake (incline)

  • Use correct horn signals for moving off in forwards/reverse

  • Test steering (while moving)

  • Test foot brakes and accelerator

Machine Operation

  • Approach stockpile with bucket at correct angle

  • Raise and crowd bucket as necessary to prevent wheelspin

  • Apply sufficient power to penetrate material

  • Ensure loader is not articulated when loading the bucket

  • Spread the load evenly and back blade to even out high spots

  • Check over shoulders and use mirrors before reversing

  • Checks to ensure the proper berms are in place

Truck loading

  • Position the truck correctly for efficient and safe loading

  • Ensure ground is level and clear of debris

  • Shake of excess material before leaving the stockpile

  • Keep the bucket low when travelling

  • Approach truck in a straight line (not articulated)

  • Raise bucket enough to clear truck body

  • Ensure loader tires do not contact truck

  • Evenly distribute the load into the truck body

Park up and shut down

  • Park machine in a safe location, on firm and level ground

  • Lower attachments to ground

  • Apply the parking brake and hydraulic lock

  • Place transmission in neutral

  • Allow engine to idle before shutting down

  • Dismount the machine safely

  • Secure machine and isolate

  • Walk around the machine looking for any new defects (post trip)

FINAL ASSESSMENT

  • Is candidate competent to operate the equipment

  • YES

  • NO, NEEDS MORE TRAINING

  • Any restrictions ?

  • Candidate name:

  • Date:

  • Assessor:

  • Date:

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.