Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Work Area (Level and Heading for Underground; Bench, Pit, Facility for Surface)
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Equipment Model and Number
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Is the cab an open or closed cab?
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Are the doors and windows in good condition? (Doors are not bent, windows and doors are able to close all the way, no air leaks, etc)
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Is the operator driving/operating equipment with the windows down?
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Discuss with the employee best practices for dust and noise control
- Conversation was had with the employee
- No conversation
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Does the A/C and/or heater work?
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Has this been documented on the pre-op card, reported to maintenance, or inspected?
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Are the cab filters in good condition?
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Ask maintenance if the cab filters are in good condition.
- Conversation was had with the employee
- No conversation
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Are the cab seals in good condition? Cracks, gaps, pulling away, missing, etc.
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Picture of Cab Seals
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Are there any holes or cracks in the cab?
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Does the equipment have a cab pressurization system and is it functioning?
- Yes, there is a cab pressurization system and it is functioning
- Yes, there is a cab pressurization system and it is not functioning
- No cab pressurization system
- Unknown
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Is the employee wearing a respirator?
- Yes
- No, make correction respirator required
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Has the cab been cleaned at the start of shift?
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Have discussion with operator on care and custody of cab for the end of shift
- Conversation was had with the employee
- No conversation
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What are the environmental conditions outside of the cab? i.e. ventilation/weather/facility
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Picture of work area outside of the cab
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Questions, comments, suggestions, and/or concerns from operator
