Title Page

  • Site conducted

  • Document number

  • Driver's name

  • MSL fleet number
  • Date

  • Mileage

Category A Faults

  • DO NOT operate the vehicle if any questions are failed on this page.

    Maintenace and safety teams will be notified immediately when a question is failed.

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Exterior checks

  • Start at the front right door and check the following

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  • Registration and Safety Sticker

  • DNO.png
  • Safety sticker expiry date

  • Registration expiry date

  • Is the buggy whip attached and the light working?

  • DNO.png
  • Are all headlights, fog lights, indicators and beacons functional?

  • DNO.png
  • Are all tyres inflated correctly?

  • DNO.png
  • Do all wheels have wheel nut indicators attached?

  • DNO.png
  • Are all wheel nut indicators aligned?

  • DNO.png
  • Are you carrying any cargo?

  • Is the cargo restrained correctly?

  • Do not proceed until the cargo is correctly restrained.

Engine checks

  • Open the hood of the vehicle and check the following

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  • Fluid Levels, Oil and Transmission

  • DO NOT DRIVE

  • Fan and Belt

  • DO NOT DRIVE

Interior checks

  • Check the following while seated in the vehicle

  • Seat and Seat Belts

  • DO NOT DRIVE

  • Cabin Gauges and Warnings

  • DO NOT DRIVE

  • Two-way Radio

  • DO NOT DRIVE

  • Fire Extinguisher

  • DO NOT DRIVE

  • Instrumentation and Switches

  • DO NOT DRIVE

  • Horn/Reverse Alarm

  • DO NOT DRIVE

  • Safemine Collision Avoidance System

  • DO NOT DRIVE

  • TrakPro Vehicle Tracking System

  • DO NOT DRIVE

  • Brakes / Park Brakes

  • DO NOT DRIVE

  • Steering System

  • DO NOT DRIVE

  • Engine Warning Light

  • DO NOT DRIVE

Category B Faults

  • Authorization is required for any failed questions before operating.

    Any failed questions will notify mechanical team.

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  • Windscreen / Window / Mirror

  • Wipers and Washer Liquid

  • Battery and Battery Water Level

  • Visibility of Asset ID

Category C Faults

  • All failures will be reported to maintenance team on inspection completion.

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  • First-aid kit in vehicle and seal unbroken

  • Fuel Level

  • Cabin Interior Condition

  • Body Damage

  • Tow Hitch

  • Wheel Chocks

  • Dash Cam & Memory Card

Operator Acknowledgement

  • I am trained, have current permits and are fit for work to operate this equipment and attachments

  • DO NOT PROCEED

  • I have a current drivers license

  • License expiry

  • DO NOT PROCEED

  • Signature (Operator)

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.