Title Page

  • Conducted on

  • Prepared by

  • Position

  • Contract

  • Location

Procedures & Systems

  • 1. Is all plant and equipment compliant to the relevant Statutory Authority requirements? E.g. item registration for defined high risk plant

  • 2. Are controls identified in the plant and equipment risk assessment implemented effectively?

Competency and understanding

  • 3. Is there evidence of inductions, qualification and Verification of Competency (VOC) for operators for high risk plant?

Plant/Equipment Design, Selection, Testing and Maintenance:

  • 4. Is selected plant and equipment fit for purpose?

  • 5. Is there evidence of pre-starts completed to detect faults, maintenance requirements etc?

  • 6. Is there evidence of effective inspection, testing and maintenance occurring as scheduled?

Emergency management:

  • 7. Are emergency procedures, rescue plans and equipment available and maintained in accordance with scheduled tests?

Human factors and behaviours:

  • 8. Are safe behaviours being demonstrated, i.e. not complacent/distracted/rushing?

  • 9. Are personnel involved in the task wearing appropriate PPE and clothing to correct standards?


  • 10. Is there effective guarding in place to protect against contact/entanglement with moving parts, parts being ejected and surfaces that are very hot/cold?

  • 11. Is the plant and equipment operated safely within parametres for which is was desiged?

  • 12. Is energised plant effectively isolated and locked out during cleaning, inspections and maintenance?

  • 13. Does work area have effective signage and demarcation in place to manage interaction between workers and vehicular movements?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.