NGM - Mobile Equipment

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.
  
  Instructions: For each critical control, select Controlled, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

• Critical Controls

• Have you completed a Team Risk Assessment prior to starting the job?

  Controlled

  At Risk

  N/A

• Is the preoperation equipment check completed with no safety or mechanical issues noted?

  Controlled

  At Risk

  N/A

• Are the seatbelts functional and being used correctly?

  Controlled

  At Risk

  N/A

• Is the operator trained and certified for the equipment?

  Controlled

  At Risk

  N/A

• Is the fire suppression system in place, operational, with current inspection tags?

  Controlled

  At Risk

  N/A

• Are the tires in operating condition? (lugs, cuts, tears, etc.)

  Controlled

  At Risk

  N/A

• Have the brake and steering tests been conducted prior to operating?

  Controlled

  At Risk

  N/A

• Is the operator driving to conditions?

  Controlled

  At Risk

  N/A

• If the equipment is parked, is it properly secured from movement, and the parking brake set?

  Controlled

  At Risk

  N/A

• Are the necessary communication devices working properly and verified?

  Controlled

  At Risk

  N/A

• Are pedestrian/equipment interaction controls/barricades/segregation in place and functioning if applicable?

  Controlled

  At Risk

  N/A

• Are adequate berms/barriers in place for equipment operating in the area?

  Controlled

  At Risk

  N/A

• Are loads secured to prevent movement? (bolts, drill steel, acetylene bottles, etc.)

  Controlled

  At Risk

  N/A

• CONTROLLED The presence of this control is verified and effective

• ATRISK This control is missing or ineffective

• NA / NO Not Applicable to this exposure situation or Not Observed

Notes