NZRB test INSPECTION TEMPLATE (3)

• Document No.

• Choose operation

  Select NZRB TAB TRACKSIDE. OB NZGR HRNZ NZTR Trackside EML Trackside Radio Trackside Services

  • NZRB
  • TAB
  • TRACKSIDE. OB
  • NZGR
  • HRNZ
  • NZTR
  • Trackside EML
  • Trackside Radio
  • Trackside Services

• Select venue region from drop down list

  UPPER NORTH ILS

  CENTRAL NORTH ISL

  SOUTH ISL

• Select venue

  Select Awapuni Highbury Foxton Otaki Trentham Waverly Wanganui / Whanganui New Plymouth Gisborne Hawkes Bay Waiarapa

  • Awapuni
  • Highbury
  • Foxton
  • Otaki
  • Trentham
  • Waverly
  • Wanganui / Whanganui
  • New Plymouth
  • Gisborne
  • Hawkes Bay
  • Waiarapa

• Conducted on

  Date

• Prepared by (please enter your name)

• Location (tap LOCATE ME, or type in address)
  Address

Select your task

• Select the inspection type

  Select vehicle PPE warehouse office refit/refurb ladder -portable ladder fixed electrical Equipment Tower Climb Trailer EWP (Elevated Work Platform) building health check

  • vehicle
  • PPE
  • warehouse
  • office
  • refit/refurb
  • ladder -portable
  • ladder fixed
  • electrical Equipment
  • Tower Climb
  • Trailer
  • EWP (Elevated Work Platform)
  • building health check

• What type of weather protection is outside the outlet?

  veranda

  open front

• Structure appears level and secure?

  Yes

  No

  N/A

• Guttering is secure and maintained in goof appearance ie not leaking, corroded, loose etc?

  Yes

  No

  N/A

• Doors

• Entrance doors hung correctly ie evenly set and level

  Yes

  No

  N/A

• Doors move freely without issue or undue noise?

  Yes

  No

  N/A

• Doors line up when closed?

  Yes

  No

  N/A

• Doors are free of damage?

  Yes

  No

  N/A

• Building exits are free of clutter or obstructions?

  Yes

  No

  N/A

• Door locks work?

  Yes

  No

  N/A

• Building access ways

• There is sufficient lighting at exits?

  Yes

  No

  N/A

• The fire exits are sign posted clearly from the outside?

  Yes

  No

  N/A

• The access is free of potential trip hazards?

  Yes

  No

  N/A

• The access ways are free of slip hazards?

  Yes

  No

  N/A

• Is the entry area tiled?

  Yes

  No

  N/A

• The tiles are in good condition I.e not broken, free of movement etc?

  Yes

  No

  N/A

• There is mobility /disabilities access to the premise?

  Yes

  No

  N/A

• If steps are present hand rails are fitted?

  Yes

  No

  N/A

• Hand rails are in good condition?

  Yes

  No

  N/A

• The building holds a current WOF? (Please note the date of inspection and record the posted certificate)

  Yes

  No

  N/A

• Emergency systems

• There are emergency system (alarm) call points at key locations?

  Yes

  No

  N/A

• There has been an emergency drill in the last six months?

  Yes

  No

  N/A

• Emergency exits clearly marked inside the building?

  Yes

  No

  N/A

• Emergency exits open without issue? Ie no obstructions.

  Yes

  No

  N/A

• Indicate what type of fire fighting equipment is present.

  Fire Extinguisher

  Fire Hose

  Dry Riser

  None

• Fire extinguishers are mounted on secure brackets?

  Yes

  No

  N/A

• Mounted in a location that has easy access and free of clutter (legally required to maintain 1square metre clearance around location)?

  Yes

  No

  N/A

• Extinguishers are current ie have been inspected in last 12months, or show pressure is good?

  Yes

  No

  N/A

• Extinguishers are correct type and size for the locations?

  Yes

  No

  N/A

• Sign posted correctly?

  Yes

  No

  N/A

• Door closes properly on the hose?

  Yes

  No

  N/A

• The hose and nozzle are in good condition? Ie free of leaks or perishing.

  Yes

  No

  N/A

• Sign posted correctly?

  Yes

  No

  N/A

• Free of obstructions which could cause access issues? (1 square metre area required around the location to be free of items or restrictions).

  Yes

  No

  N/A

• Dry riser is able to easily accessed in an emergency? Ie free from obstruction

  Yes

  No

  N/A

• Dry riser is secured and locked?

  Yes

  No

  N/A

• There are smoke detectors in the building?

  Yes

  No

  N/A

• Smoke detectors appear in good condition?

  Yes

  No

  N/A

• Is there a fire suppressant system?

  Yes

  No

  N/A

• Sprinkler heads are in good condition ie free from dust build up or corrosion?

  Yes

  No

  N/A

• Ceilings (internal) only

  Yes

  No

  N/A

• Ceiling is free from leaks or dripping water?

  Yes

  No

  N/A

• Ceiling is free of mould patches and fungus growth (new or old)?

  Yes

  No

  N/A

• Internal ceiling structure or open internal roof structure?

  internal ceiling structure

  open internal roof structure

• Solid single ceiling structure or suspended internal ceiling structure?

  solid

  suspended

• Ceiling paint is in good condition I.e not peeling etc?

  Yes

  No

  N/A

• Ceiling panels are in good condition? Ie no water stains, discolouration, peeling paint etc.

  Yes

  No

  N/A

• Kitchen facilities

• Tidy?

  Yes

  No

  N/A

• Plumbing working ie drains cleanly

  Yes

  No

  N/A

• Tap fixtures working?

  Yes

  No

  N/A

• Hot water temperature is less than 55 degrees?

  Yes

  No

  N/A

• Water runs clear and clean?

  Yes

  No

  N/A

• Free of noise in plumbing when water is run?

  Yes

  No

  N/A

• Walls external.

• Identify type of exterior walls.

  brick

  concrete/masonry

  fibre cement /asbestos

  plastered

  timber

• Walls are in good condition? Ie free from cracks, broken sections, crumbling etc.

  Yes

  No

  N/A

• Exterior is painted?

  Yes

  No

  N/A

• Paint is free of peeling and maintained in good condition.

  Yes

  No

  N/A

• Walls internal.

• Identify interior cladding of the building.

  brick

  masonry /concrete

  timber

  gib

  other

• No obvious structural defects in the walls? Ie cracks, warping, movement etc in masonry or gib.

  Yes

  No

  N/A

• Free of water stains, mould, or rot etc?

  Yes

  No

  N/A

• Fixtures are secure?

  Yes

  No

  N/A

• Toilet facilities.

• Clean?

  Yes

  No

  N/A

• Floor in good condition? Ie free of cracks, tears, or other damage.

  Yes

  No

  N/A

• Plumbing fixtures and toilet in good condition?

  Yes

  No

  N/A

• Air conditioning present?

  Yes

  No

  N/A

• Ventilation - ducting is free of obstructions?

  Yes

  No

  N/A

• Ventilation - free of vibration or noise from system?

  Yes

  No

  N/A

• Ventilation - Consistent air flow through out premise?

  Yes

  No

  N/A

• Ventilation - air quality free from unusual odours or smells?

  Yes

  No

  N/A

• Ventilation and air quality - clean air movement free of obvious dust etc?

  Yes

  No

  N/A

• Windows - are in good condition? Ie frames in good condition, no undue movement, or broken glass.

  Yes

  No

  N/A

• Lighting.

• Reasonable lighting levels present? I.e not glaring and not to dim causing eye Strain?

  Yes

  No

  N/A

• Lighting level in gaming room?

• Lighting levels in main customer betting area.

• Lighting levels in kitchen

• Lighting levels at work bench.

• Lights functioning correctly? No lights flickering, or failure to turn on when switched on.

  Yes

  No

  N/A

• Light mountings in good condition? Ie not appear to be PCB material, not flaking, or hanging down.

  Yes

  No

  N/A

• Electrical

• Plug outlets are maintained in good condition?

  Yes

  No

  N/A

• Mains switch board is secured and locked to prevent unauthorised access?

  Yes

  No

  N/A

• Fixed wired items (if visible) in good condition?

  Yes

  No

  N/A

• Flooring is in good condition I.e free of trip hazards, soft spots, or uneven sections?

  Yes

  No

  N/A

• Is the thermal comfort set to the correct temperature? I.e 22 degrees for sedentary operations, 16 degrees for heavy manual work.

  Yes

  No

  N/A

• Humidity is 40% or less

  Yes

  No

  N/A

• Any other building issues to be noted (discuss with tenants).

• WOF current?

  Yes

  No

  N/A

• PLEASE ARRANGE FOR THIS IMMEDIATELY WITH YOUR MANAGER. Vehicle operators are reminded to check vehicle certifications regularly to prevent these from expiring. An expired certification is a penalty under NZ transport laws and can incur fines for the vehicle operator.

• COF current?

  Yes

  No

  N/A

• PLEASE ARRANGE FOR THIS IMMEDIATELY WITH YOUR MANAGER. Vehicle operators are reminded to check vehicle certifications regularly to prevent these from expiring. An expired certification is a penalty under NZ transport laws and can incur fines for the vehicle operator.

• Vehicle registration is current -please note you should inform you Manager if the registration is due within 2 weeks of this inspection.

  Yes

  No

  N/A

• PLEASE ARRANGE FOR THIS IMMEDIATELY WITH YOUR MANAGER. Vehicle operators are reminded to check vehicle certifications regularly to prevent these from expiring. An expired certification is a penalty under NZ transport laws and can incur fines for the vehicle operator.

• Diesel mileage is current?

  Yes

  No

  N/A

• PLEASE ARRANGE FOR THIS IMMEDIATELY WITH YOUR MANAGER. Vehicle operators are reminded to check diesel mileage on any diesel vehicle they operate to prevent these from lapsing and incurring excess fees. Exceeding mileage is a penalty under NZ transport laws and can incur fines for the vehicle operator.

• Tyres in good condition I.e Tread has good depth?

  Yes

  No

  N/A

• PLEASE ARRANGE WITH YOUR MANAGER FOR YOUR VEHICLE TO HAVE A TYRE CHECK AND CHANGE PLUS TYRE ROTATION WITH THE NZRB APPROVED AUTOMOTIVE SERVICING COMPANY.

• Vehicle is tidy inside I.e. Free from rubbish and clean?

  Yes

  No

  N/A

• Vehicle operators and users are reminded to ensure they maintain a clean and tidy vehicle at all times.

• Vehicle exterior is clean and tidy?

  Yes

  No

  N/A

• Please make arrangements to clean the vehicle - perception in presentation is essential for NZRB and our clients.

• Vehicle is free from damage I.e dents, paint scrapes, scratches, corrosion etc?

  Yes

  No

  N/A

• Please make notes on the specific issues (damage or wear and tear) and notify your manager to have this remedied ASAP. If the vehicle is damaged due to an accident please fi,e both an incident report and insurance damage report with your manager.

• Head lamps, indicators (hazard lights included) working?

  Yes

  No

  N/A

• Vehicle light visibility is essential as a road user. Please make necessary arrangements to have the defects remedied with your manager.

• Oil and engine coolant ok?

  Yes

  No

  N/A

• Please make note of the amount (approx) you have to top these up by, and monitor these frequently. Good oil levels will help prevent excess engine wear and increase the efficiency of the engine.

• Windscreen is clean and free from dirt/film build up? (Interior and exterior)

  Yes

  No

  N/A

• Dirt and film build up can cause glare or flaring of light affecting your safe driving visibility. A clean rag with a small amount of windscreen cleaner will assist in removing any dirt film from the inside of the windscreen effectively.

• Loads (both inside and outside) are secure / stowed / fastened and correctly balanced to prevent load shift/movement, vehicle instability, or load loss during transit?

  Yes

  No

  N/A

• Please note your current vehicle odometer.

• Vehicle operators are reminded to ensure equipment is stowed correctly prior to transit. New Zealand transport legislation requires the operator to secure all loads properly. Failure to do this can lead to injury, accidents, and fines.
  
  If you require further remedial action please note your recmmndations in this report and ensure your manager us notified.

• Any additional notes?

• Please select the PPE type you are inspecting

  Select General PPE Working at heights PPE

  • General PPE
  • Working at heights PPE

• Your safety footwear is in good condition - I.e. ankle supporting lace up - no steels exposed, good sole tread present, no rips or tears, dry for we Are?

  Yes

  No

  N/A

• Where safety footwear requires replacement please notify your manager so a replacement pair can be arranged through NZRB approved suppliers NZ Safety ASAP.

• Your high visibility vest is in good conditions? I.e. Not faded, no rips or tears, can still be closed up.

  Yes

  No

  N/A

• Please notify your manager so a replacement can be arranged ASAP.

• You have access to safety glasses in good condition? Ie free from scratched lenses, fit securely with pressure or squeezing the temple region and sit crrectly on your nose bridge.

  Yes

  No

  N/A

• Please arrangement of a replacement pair with your direct manager.

• Gloves are in good condition and suitable to the task? I.e leather working man gloves, free from holes or tears and correct size.

  Yes

  No

  N/A

• Please arrangement of a replacement pair with your direct manager.

• Any additional notes

• Harness is in current certain and fit for purpose condition? Ie certificate of inspection current for 10year period and free of fraying, warps in buckles / connectors, obvious metal fatigue, no mold, or paint / solvents on webbing.

  Yes

  No

  N/A

• Rescue line in good working condition and current certification.

  Yes

  No

  N/A

• Tag your equipment out as defective and arrange with you management for immediate repairs by the supplier or for a PO for replacement items.

• Gear stored safely and free from sources of potential damage in dry condition?

  Yes

  No

  N/A

• Climbing equipment must be stowed in a safe and dry manner at all times.

• Equipment holds current test and tag

  Yes

  No

  N/A

• Equipment is in good physical condition I.e no compression on leads damage to sheaths, or bare wire exposed.

  Yes

  No

  N/A

• Current WOF?

  Yes

  No

  N/A

• Tyres in good condition?

  Yes

  No

  N/A

• Current vehicle registration?

  Yes

  No

  N/A

• Coupling in good condition?

  Yes

  No

  N/A

• Chain link present and dLink fits correctly?

  Yes

  No

  N/A

• Load limit clearly marked?

  Yes

  No

  N/A

• Trailer is in good conditions?

  Yes

  No

  N/A

• Indicators a brake lights function correctly?

  Yes

  No

  N/A

• Sufficient lighting maintained

  Yes

  No

  N/A

• Access ways maintained clear (minimum of 1.2 metres clearance legally required)

  Yes

  No

  N/A

• Emergency exits sign posted and clear

  Yes

  No

  N/A

• Emergency procedures posted at key locations, I.e office, doors, emergency exits

  Yes

  No

  N/A

• Materials safely stowed to prevent overloading of shelving, and falling items

  Yes

  No

  N/A

• Vehicle pedestrian access clearly marked out

  Yes

  No

  N/A

• Appropriate hazard risk warning signs present

  Yes

  No

  N/A

• First aid kit and fire extinguishers maintained?

  Yes

  No

  N/A

• Work spaces clear of clutter

  Yes

  No

  N/A

• Area is clear of rubbish and General waste

  Yes

  No

  N/A

• Hazardous materials (substances) properly contained

  Yes

  No

  N/A

• Copy of company safety and health procedures maintained and available to Workers?

  Yes

  No

  N/A

• Sufficient lighting maintained in office areas

  Yes

  No

  N/A

• SIMS charts posted?

  Yes

  No

  N/A

• Names of fire wardens and HSR, HSA posted?

  Yes

  No

  N/A

• SIMS chart is relevant to the locations?

  Yes

  No

  N/A

• Copy of company HSE policies posted where visible to Workers and visitors?

  Yes

  No

  N/A

• Health and safety notice board displayed, tidy, and currently?

  Yes

  No

  N/A

• Copy of Fire Wardens and HSR, HSA, posted for each floor?

  Yes

  No

  N/A

• CDEM cabinets present?

  Yes

  No

  N/A

• Cabinet has tamper seal present sealing door?

  Yes

  No

  N/A

• Tamper seal shows check performed within last 12months?

  Yes

  No

  N/A

• Electrical cables secure under desks and tidy?

  Yes

  No

  N/A

• Electrical outlets are in good condition?

  Yes

  No

  N/A

• Electrical cables in current test and tag as per ASNZS 3760:1:2012

  Yes

  No

  N/A

• Work spaces free of clutter, on top, under, and around desk areas?

  Yes

  No

  N/A

• Sufficient clearance in access ways?

  Yes

  No

  N/A

• Stairwells free of obstructions?

  Yes

  No

  N/A

• First aid kit and fire extinguisher maintained at key points? Must be checked to ensure in current fit for purpose state.

  Yes

  No

  N/A

• Thermal temperature is good for sedentary office based work? I.e should be between 20-23 degrees Celsius

  Yes

  No

  N/A

• Waste has been removed from the office?

  Yes

  No

  N/A

• Office ceiling panels secure and free from movement?

  Yes

  No

  N/A

• Office has good ventilation?

  Yes

  No

  N/A

• Office is free from General unpleasant odours?

  Yes

  No

  N/A

• Office is free from direct sunglare?

  Yes

  No

  N/A

• No materials stowed within 1square metre of fire fighting equipment?

  Yes

  No

  N/A

• Please enter the details of the tower name.

• Please select type of tower.

  TIMBER TOWER

  STEEL TOWER

  COMBINATION TOWER

• Timber is free from visual rot (physical appearance only)

  Yes

  No

  N/A

• Free heavy rust / corrosion?

  Yes

  No

  N/A

• Free from rot or corrosion?

  Yes

  No

  N/A

• Tower is ramp, steps, or ladder access?

  ladder access

  ramp access

  step / stairs access

• Hand rails are present at heights greater than 1metre off the ground?

  Yes

  No

  N/A

• Hand rails are in good conditions? I.e free of heavy movement, rot or heavy corrosion?

  Yes

  No

  N/A

• The tower has certified anchor points? I.e. Serial number and load rating punch marked or tagged? These are for climbing and load rigging.

  Yes

  No

  N/A

• Ladder attachment is secure and free from rust, warping, fractures, or bends in rungs, or breaks?

  Yes

  No

  N/A

• Any ladder access extends 1metre beyond the top step into

  Yes

  No

  N/A

• Tower access door is in a good physical state?

  Yes

  No

  N/A

• Tower has proper containment /edge protections?

  Yes

  No

  N/A

• The tower pillars appear stable and in good condition?

  Yes

  No

  N/A

• Tower is clean and hygienic i.e. Free of animal / waste and rubbish?

  Yes

  No

  N/A

• Ladder is industrial rated? I.e bolted or Moulder no rivetting

  Yes

  No

  N/A

• Ladder footings in good condition? Free from perishing, splitting, fading, smooth wear etc.

  Yes

  No

  N/A

• Rungs in good condition? Free from warps, fractures, bends heavy corrosion or rot.

  Yes

  No

  N/A

• Ladder stays in good condition? I.e. Free from fractures, bends, warping, rot or corrosion.

  Yes

  No

  N/A

• Lock bars function correctly? Ie pin locks in good condition, free from slipping, free from self modifications

  Yes

  No

  N/A

• Ladder seats correctly when positioned for proper stability? I.e. Doesn't wabble when setup.

  Yes

  No

  N/A

• There are no modifications made to the ladder? I.e. Holes drilled, self repairs etc.

  Yes

  No

  N/A

• Ladder is secured to the structure safely with nil movement when tested?

  Yes

  No

  N/A

• Attachment points appear from from obvious corrosion, warping, fractures etc.

  Yes

  No

  N/A

• Rungs free from warping, bending, fractures, or obvious fatigue and corrosion or rot?

  Yes

  No

  N/A

• Stays (vertical runs) free from warping, fractures, splintering, corrosion, rot, or obvious fatigue?

  Yes

  No

  N/A

• Top of ladder extends 1 metre past the top point with hand grip area from person climbing?

  Yes

  No

  N/A

• Ladder is industrial rated as per ASNZS 1892:1:1996

  Yes

  No

  N/A

• Signs displayed restricting access to authorised personnel only?

  Yes

  No

  N/A

• Sign in register maintained by contractors

  Yes

  No

  N/A

• There is an established emergency assembly point (ask several persons on site to verify)?

  Yes

  No

  N/A

• Hazards specific to the site are displayed.

  Yes

  No

  N/A

• Controls for the hazards are displayed

  Yes

  No

  N/A

• Controls are being practiced in the workplaces?

  Yes

  No

  N/A

• Personal protective equipment is being worn and used correctly as required?

  Yes

  No

  N/A

• Safety footwear in use?

  Yes

  No

  N/A

• High visibility vest in use?

  Yes

  No

  N/A

• Safety glasses or other proper eye protection being worn?

  Yes

  No

  N/A

• Hearing protection being worn where required?

  Yes

  No

  N/A

• Hard hats and or bump caps worn where there are overhead or restrictive work space hazards and risks?

  Yes

  No

  N/A

• Housekeeping is tidy and well maintained I.e waste is removed and clutter free work areas?

  Yes

  No

  N/A

• Waste is removed and disposed during build progress and not accumulated?

  Yes

  No

  N/A

• Power tools on site?

  Yes

  No

  N/A

• Leads and power tools tagged and in current test date I.e. 3monthly?

  Yes

  No

  N/A

• Power leads in good working fit for purpose conditions?

  Yes

  No

  N/A

• Leads not posing a trip hazard to people?

  Yes

  No

  N/A

• Commercial RCD's only in use on site?

  Yes

  No

  N/A

• Multi plugs are not being piggy backed I.e one or more plugged into a single multi plug outlet?

  Yes

  No

  N/A

• Scaffolding in use on site

  Yes

  No

  N/A

• Scaffold is set up in a safe manner I.e. Stable, level, locked in position, correct cross bar positioning, interlocked correctly?

  Yes

  No

  N/A

• Is the scaffolding set up greater than or equal to 5metres in height?

  Yes

  No

  N/A

• The contractor holds evidence of Notifiable works on site for the scaffolding greater than 5metres?

  Yes

  No

  N/A

• Registered scaffolders inspection certificate present and current?

  Yes

  No

  N/A

• Kick boards present?

  Yes

  No

  N/A

• Edge protection is in place on the working platform? I.e. 1100mm top rail and a 600mm mid rail.

  Yes

  No

  N/A

• Ladders in use on site?

  Yes

  No

  N/A

• Ladders are in good condition ie free from cracks, warps, obvious corrosion, bends, or breaks?

  Yes

  No

  N/A

• Where electricians are using ladders they are fibre glass to eliminate electrical conduction?

  Yes

  No

  N/A

• Ladders are set up correctly?

  Yes

  No

  N/A

• Ladders are industrial rated? Ie bolted joints and no rivets. ASNZS 1892:1996

  Yes

  No

  N/A

• Access ladders are secured where possible to prevent movement during access and use?

  Yes

  No

  N/A

• Access ladders extend 1metre beyond the point of access?

  Yes

  No

  N/A

• Dust is controlled during all work I.e. Gib stopping, sanding, power tool work etc?

  Yes

  No

  N/A

• Contractors can show proof of NZRB approved ID?

  Yes

  No

  N/A

• There are ablution facilities (toilets and running water) available to the crews on site?

  Yes

  No

  N/A

• Facilities are maintained in a tidy and hygienic condition?

  Yes

  No

  N/A

• Any hazardous substances on site?

  Yes

  No

  N/A

• There are material safety data sheets (MSDS) in hard copy or e-copy on site for these hazardous substances?

  Yes

  No

  N/A

• Hazardous substances are stored safely?

  Yes

  No

  N/A

• Emergency first aid maintained on site?

  Yes

  No

  N/A

• There is at least 1 trained first aider on site?

  Yes

  No

  N/A

• Emergency fire extinguishers maintained on site I.e dry powder ABE only?

  Yes

  No

  N/A

• Do signature of the lead contractor and name should be recorded.

  Sign

• MEWP is in current test and certificate (displayed on the plant)?

  Yes

  No

  N/A

• MEWP cannot be used and must be tagged out and returned to the supplier via the Race Club. DO NOT operate

• Wiring appear as in good condition from a quick visual POV?

  Yes

  No

  N/A

• MEWP is designed for outside use - I.e all terrain tyres in good condition?

  Yes

  No

  N/A

• free from fluid leaks - I.e fuel, hydraulic fluid etc?

  Yes

  No

  N/A

• The equipment must be tagged out as defective if hydraulic fluid is observed to be leaking from the MEWP and the supplier notified of the need to repair prior to operation - this should be notified to the race club operations and suppliers. Spilt or leaking fuel should be cleaned up immediately.

• MEWP controls in good physical appearance and operational?

  Yes

  No

  N/A

• Audible warning beacon activates when moved or being started up?

  Yes

  No

  N/A

• There is an anchor point for wearing a harness and clipping onto?

  Yes

  No

  N/A

• there is a dead man foot pedal installed on the MEWP?

  Yes

  No

  N/A

• Where used on non-compacted ground I.e grass or dirt the MEWP has load spreaders or concrete pads positioned to allow the MEWP footings to be deployed safely?

  Yes

  No

  N/A

• Footings (stabiliser) in good working order?

  Yes

  No

  N/A

• MEWP must NOT be used. Supplier must be notified of the defect and the equipment tagged out to prevent use. DO NOT use under any circumstance - race course supplier must be notified.

  Yes

  No

  N/A

• Free from obvious metal fatigue or damage which may affect the safe and healthy operation of the equipment?

  Yes

  No

  N/A

• Operator holds proper training and qualifications I.e holds relevant licence for operating? Please provide a licence photo or other evidence of training

  Yes

  No

  N/A

• Where positioned for use the MEWP will be isolated from the public to prevent public and other persons walking into the area of operation?

  Yes

  No

  N/A

• The area must be isolated and clearly demarcated prior to commencing operations - this is to ensure not person enters the area or the potential drop zone during operations.

• Additional observations and notes:

• Signature of person performing inspection

  Sign