PART A - EQUIPMENT INTRODUCTION TO SITE

• Compliance Sticker Number

• Date Issued

  Date

• Equipment Owner Company

• Contact Person

• Contact Number

• Contact Email

• Equipment description

• Model

• Manufacturer

  Manufacturer 1

  Manufacturer 2

  Manufacturer 3

• Year of Manufacturer

• Call Sign / Unit ID

• Serial Number / Identification Number

• Equipment Design registration

• Equipment TARE

• Equipment GVM

• SMU Hours / Odometer

• Travel Height (meters)

• Maximum Extended Height (meters)

• Date on site

  Date

• Department (eg. Maintenance Production / CHPP)

  Maintenance Production

  CHPP

• All supporting documentation and information as requested in this section is to be physically or electronically
  attached to this document PRIOR to equipment arriving on site. Supporting documentation is MANDATORY.
  
  Provide comment / justification for any missing documentation.
  
  Completed Electronic Copies to be emailed to cmjv_maintenance_engineering@peabodyenergy.com
  
  Email subject to include ‘ITS Unit ID’

• Supporting documentation uploaded

  Yes

  No

  N/A

• Please provide comments / justification for missing documentation

Section 5.1: Supporting Documents - Required for all equipment

• Operability and Maintainability Risk Assessment – required for all vehicles

  Yes

  No

  N/A

• Service History – provide summary of defects and at least 12 months of servicing and repairs

  Yes

  No

  N/A

• Modification – provide summary of any modifications and photos of compliance plates

  Yes

  No

  As per OEM

• This section is to be filled out with the details of the Vendor Contact or Equipment Owner

• Is the equipment to be fueled and / or maintained by Vendor?

  No

  Vendor Fueled

  Vendor Maintained

• Name

• Position

• Company

• Date

• Signature

  Sign

• Additional Comments

Section 7: Sign-Off Peabody Contract Owner or Delegate

• Yes

  No

  N/A