Pipeline Safety Audit & Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time audit began

  Date

VEHICLE DESCRIPTION

• Photograph of Vehicle Being Inspected

  Media

• Year

  Select 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

  • 2000
  • 2001
  • 2002
  • 2003
  • 2004
  • 2005
  • 2006
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014
  • 2015
  • 2016
  • 2017
  • 2018
  • 2019
  • 2020

• Make

• Model

• VIN (Vehicle Inspection Number)

• Drivers License Number

• License State

  Western Australia

• Odometer Reading at Inspection

EXTERIOR LIGHTING

• High and Low Beams Operational

  Yes

  No

  N/A

• Clearance, Marker Lights Operational

  Yes

  No

  N/A

• Left and Right Tail Lights Operational

  Yes

  No

  N/A

• Left and Right Front Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Rear Turn Signals Operational

  Yes

  No

  N/A

• Left and Right Break Lights Operational

  Yes

  No

  N/A

• Left and Right Back-Up Lights Operational

  Yes

  No

  N/A

• License Plate Light Operational

  Yes

  No

  N/A

• Audible Back-up Alarm Operational

  Yes

  No

  N/A

EXTERIOR BODY AND GLASS (Take Photos of any noted damage)

• Windshield Free of Cracks and Chips

  Yes

  No

  N/A

• Front Hood, Grill and Bumper free of Damage

  Yes

  No

  N/A

• Left Mirrors adjustable and Free of Damage

  Yes

  No

  N/A

• Left Fender Free of Damage

  Yes

  No

  N/A

• Left Door Free of Damage

  Yes

  No

  N/A

• Left Side Free of Damage

  Yes

  No

  N/A

• Left Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Rear WIndow Free of Cracks and Chips

  Yes

  No

  N/A

• Rear of Vehicle and Bumper Free of Damage (Tailgate if included)

  Yes

  No

  N/A

• Right Side Free of Damage

  Yes

  No

  N/A

• License Plate / Tag is current and not expired / Note expiration date and verify to registration

  Yes

  No

  N/A

• Right Side Windows Free of Cracks and Chips

  Yes

  No

  N/A

• Right Door Free of Damage

  Yes

  No

  N/A

• Right Front Fender Free of Damage

  Yes

  No

  N/A

• Right Mirror Adjustable and Free of Damage

  Yes

  No

  N/A

• Vehicle is Clean and Free of Road Grime and Dirt

  Yes

  No

  N/A

Tyres

• Front Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Driver (INSIDE) Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)

  Safe

  At Risk

  N/A

• Rear Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Rear Passenger (INSIDE) Driver Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall (If Dual Tire Vehicle)

  Safe

  At Risk

  N/A

• Front Passenger Tire in Good Repair with no Visible Signs of Wear or Cracking in Sidewall

  Safe

  At Risk

  N/A

• Adequate Spare Tire is Available if Necessary in Good Repair with No Visible Signs of Wear or Cracking in Sidewall

  Yes

  No

  N/A

• Front Driver and Passenger Wheel/Tire Trim Rings in Place

  Yes

  No

  N/A

• Rear Driver and Passenger Wheel/Tire Trim Rings in Place

  Yes

  No

  N/A

INTERIOR

• Driver Seat in Good Repair

  Safe

  At Risk

  N/A

• Driver Seat Belt Operational with Shoulder Harness

  Safe

  At Risk

  N/A

• Windshield Wipers Functioning Appropriately

  Yes

  No

  N/A

• Windshield Washer Fluid Functioning and Appropriately Wetting Windshield to Clean

  Yes

  No

  N/A

• Heater and Defroster Operational

  Yes

  No

  N/A

• Air Conditioning Operational

  Yes

  No

  N/A

• Dashboard Lights Operational

  Yes

  No

  N/A

• All Gauges are Operating and Show within Appropriate Ranges

  Yes

  No

  N/A

• Interior Compartment Lights Operational

  Yes

  No

  N/A

• Under Storage Lights Operational

  Yes

  No

  N/A

• Bus Door Operational

  Yes

  No

  N/A

• Entry Grab Bar/Rail Secure

  Safe

  At Risk

  N/A

• Interior is Clean and Free of Loose Objects

  Yes

  No

  N/A

• Television and DVD Operational

  Yes

  No

  N/A

• PA System Operational

  Yes

  No

  N/A

• Passenger Seat Belts Operational

  Safe

  At Risk

  N/A

• Passenger Seats in Good Repair

  Safe

  At Risk

  N/A

SAFETY EQUIPMENT

• Beacon fitted and operational

  Yes

  No

  N/A

• Whip aerial flag fitted?

  Safe

  At Risk

  N/A

• 40 channel UHF fitted?

  Yes

  No

  N/A

• Battery isolation switch fitted?

  Yes

  No

  N/A

• Hi viz mining tape fitted?

  Yes

  No

  N/A

• 2x wheel chocks supplied inside cab?

  Yes

  No

  N/A

• First aid kit supplied?

  Yes

  No

  N/A

• Headlights on feature fitted to vehicle?

  Yes

  No

  N/A

• Handbrake alarm fitted to vehicle?

  Yes

  No

  N/A

• Reverse beeper fitted and operational?

  Yes

  No

  N/A

• 3x safety triangles supplied?

  Yes

  No

  N/A

• All jack and tools required for wheel change supplied and tagged?

  Yes

  No

  N/A

• Second spare tyre supplied?

  Yes

  No

  N/A

• Additional specialty equipment provided ( spot lights, tool kits ect)

• Does the vehicle have safe access & egress

  Yes

  No

  N/A

• Fire extinguisher pressure correct and inspection tag in date?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Overhead lights fitted and operational?

  Safe

  At Risk

  N/A

• Roll bar installed?

  Yes

  No

  N/A

General

• Has daily per start checklist been filled out

  Yes

  No

  N/A

• Does the truck driver carry his log-book

  Yes

  No

  N/A

• Is truck carrying EPA books

  Yes

  No

  N/A

• Is truck carrying accident report forms

  Yes

  No

  N/A

• Does driver a a copy of his SWMS

  Yes

  No

  N/A

• Does driver operator carry the appropriate PPE for the task

  Yes

  No

  N/A

• Is PPE serviceable

  Yes

  No

  N/A

• Are daily checklists being handed in on Tuesdays with fuel receipts

  Yes

  No

  N/A

REQUIRED DOCUMENTATION

• Next service due (Klm's)

• Kim's for next service due?

  Yes

  No

  N/A

• Date of Last Service (List Details of Last Service, i.e. New Tires, Oil Change, ect...)

  Date

• Are Adequate Preventative Maintenance and Service Repair Records Kept

  Yes

  No

  N/A

SIGNATURES

• Signature of Auditor

  Sign