Monthly Maintenance Check - Vehicle, Equipment & PPE

• JT Operator:

• Conducted on

  Date

Vehicle

• Is your vehicle safe and fit for use?

  Yes

  No

• Is your WOF current?

  Yes

  No

• Is your registration current?

  Yes

  No

Ladder

• Stiles (Legs/Feet) - These must not be bent or damaged

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Rungs or Steps - Must not be bent, loose, worn or split

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Braces between steps and stiles or backframe - must not be bent, loose or disconnected

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Locking Bars - Must not be damaged or missing

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Non-slip shoes - Must not be worn out or missing

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

Water Blaster

• Fuel Tank - Maximum fuel levels kept at least 10mm below the top of the tank to allow for expansion.

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Water Connections - These are kept tight and that there are no leaks from the machine.

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Pressure Regulating Valve - If the nozzle becomes blocked or a restriction occurs on the discharge<br>side of the pump a buildup of pressure will form in the system, the bypass/unloader valve will<br>then activate to relieve the excess pressure. DO NOT TAMPER WITH THE UNLOADER<br>VALVE

  Safe

  At Risk (Action Required)

• Contact an authorised service agent to perform any adjustments needed. DO NOT CONTINUE USING THE MACHINE UNTIL IT HAS BEEN FIXED.

• Nozzle - Must not be worn

  Safe

  At Risk (Action Required)

• Nozzle must be replaced. DO NOT USE UNTIL IT HAS BEEN REPLACED.

• Inlet & Discharge Valves - Must not be worn. dirty or clogged.

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

• Hose

  Safe

  At Risk (Action Required)

• Steps you will take to rectify the issue

Safety Cones & Barriers

• Do you have a sufficient amount of cones and barriers to ensure your work sites can be correctly isolated?

  Safe

  At Risk (Action Required)

• Obtain a sufficient amount of Safety Cones and/or barriers to ensure your work sites can be isolated correctly.

Hazard Signs

• Hazard Signs - Must not be worn to the degree that the information cannot be seen clearly

  Safe

  At Risk (Action Required)

• Obtain a new Hazard Board

Harness, Ropes & Lanyards

• Do you have a Harness/Ropes/Lanyard for use on JT work sites?

  Yes

  No

• Impact Indicator

  Safe

  At Risk (Action Required)

• D-Rings

  Safe

  At Risk (Action Required)

• D-Ring Plate

  Safe

  At Risk (Action Required)

• Buckles

  Safe

  At Risk (Action Required)

• Connectors

  Safe

  At Risk (Action Required)

• Labels - Must be present, attached and legible

  Yes

  No

• Plastic Keepers

  Safe

  At Risk (Action Required)

• Wire Rope

  Safe

  At Risk (Action Required)

• Webbing

  Safe

  At Risk (Action Required)

• Shock Absorber

  Safe

  At Risk (Action Required)

• Stitching

  Safe

  At Risk (Action Required)

• Rope

  Safe

  At Risk (Action Required)

Hi-Vis

• Is your Hi-Vis clean and in good condition

  Yes

  No

Gloves

• Gloves - In good condition

  Yes

  No

Ear Protection

• Ear Protection - In good condition

  Yes

  No

Fire Extinguisher

• Is your Fire extinguisher certified? (NZ standards state that fire extinguishers must checked every 12 months)

  Yes

  No

  N/A

• Please provide the date extinguisher was certified

  Date

• Please provide the date you intend to certify your extinguisher

  Date

First Aid Kit

• Is your First Aid Kit fully stocked?

  Yes

  No

• Please list the missing items from your first aid kit

• Please provide date for which you intend first aid kit to be fully stocked

  Date

• Please list the name of any gear not mentioned above i.e. Floodlights, leaf blower, water tank, hot water unit, SweepnScrub, pump sprayer, hand held water blaster etc.

• Notes:

• I declare that the maintenance checks were performed by me personally and all the information provided is true and correct.

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