Title Page
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Client / Site
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Conducted on
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Conducted by
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Driver Name
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Prime Mover Fleet Number and Registration
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Location
Driver PPE Bag
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Appropriate PPE Bag (in good condition)
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Chemically Resistant Gloves (minimum of 2 pairs)
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Riggers Gloves (minimum of 2 pairs)
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Safety Glasses
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Safety Goggles (chemically resistant)
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Hearing Protection
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Eye Wash Refill Bottle (minimum 250mL)
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Eye Wash Refill Bottle Within Expiry Date
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Full Face Respirator (Cyanide)
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Respirator Filters (minimum of 2 spares)
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Respirator Appropriately Stored
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HCN Gas Monitor
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HCN Gas Monitor Serial Number
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HCN Gas Monitor Calibration Date (due for calibration every 6 months)
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PPE Alcohol Wipes
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Safety Helmet
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Full Sun Brim (either hat or brim for helmet)
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Full Face Shield with Chin Guard
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High Visibility Long Sleeve Shirt and Pants
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Chemical Resistant Coveralls (disposable)
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Full Chemical Suit or PVC Pants & Jacket
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Steel Cap Gum Boots
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Torch (working)
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Insect Repellent (non-aerosol)
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Danger/Caution Tape
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Sunscreen
Prime Mover PPE
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Eye Wash Bottle Fitted in Cab of Vehicle (minimum 250mL)
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Eye Wash Refill Bottle Within Expiry Date
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First Aid Kit
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First Aid Kit Last Inspection Date
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Emergency Escape Respirator (SCBA)
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Emergency Escape Respirator Bag Number and Expiry Date
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Duress Alarm Fitted
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Fire Extinguishers:<br>- 1x 10B on Prime Mover<br>- 1x 60B or 2x 30B on Trailer
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Extinguishers are within service date (6 months from last service date)
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Reflective Triangles
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Wheel Chocks
