Title Page

  • Conducted on

  • Checked by

  • Position

  • Contract

  • Location

Procedures and Systems:

  • 1. Are controls identified in the plant risk assessment, SWMS and Traffic Management Plans (TMP) implemented effectively?

  • 2. Have simultaneous operation / interface controls been implemented effectively to manage conflicting activities?

Competency & understanding:

  • 3. Is there evidence of inductions, qualifications and Verification of Competency (VOC) for Operators?

Plant/Equipment Design, Selection, Testing and Maintenance:

  • 4. Is selected plant fit for purpose and in good condition?

  • 5. Are pre-starts and maintenance completed as scheduled to detect faults, maintenance requirements etc.?

  • 6. Does mobile plant have relevant Roll Over Protections Systems (ROPS) where applicable?

Emergency Management:

  • 7. Have emergency procedures, equipment and rescue plans been implemented in accordance with scheduled tests?

Human Factors and Behaviours:

  • 8. Where possible, is protection in place to prevent plant from coming in contact with the energy source, e.g. isolate / avoid power lines?

  • 9. Are safe behaviours being demonstrated, i.e. not complacent/distracted/rushing?


  • 10. Are communication controls implemented effectively? e.g. positive communication and spotters?

  • 11. Is signage, demarcations of pedestrian walkways and restricted areas in place and effective?

  • 12. Are warning devices, detection systems and lights fitted and operational?


  • 13. Are isolation controls effective to manage interaction between pedestrians and mobile plant, e.g. access point design and exclusion zones?

Clothing and Protection:

  • 14. Are personnel involved in the task wearing appropriate PPE and hi visibility clothing?

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.