PWM-WHS017 Pre-start Form

• Pre-start completed by

• Pre-start conducted on

  Date

• IMPORTANT: COMPLETE THIS PRE-START EVERY MORNING BEFORE OPERATING PLANT.

• Machine Name:

• Model Number:

• Plate S/N:

Engine - Confirm that the below items have passed

• Engine oil level suitable

  Yes

  No

  N/A

• Engine coolant full and operable

  Yes

  No

  N/A

• Steering & brake fluid sufficient

  Yes

  No

  N/A

• Leaks, seals & hoses

  Yes

  No

  N/A

Vehicle Body - Confirm that the below items have passed

• Panels, doors & mirrors

  Yes

  No

  N/A

• Mud flaps & windscreen wipers

  Yes

  No

  N/A

• Registration plates/signs

  Yes

  No

  N/A

• Fixtures, fittings & tray

  Yes

  No

  N/A

Electrical - Confirm that the below items have passed

• Headlights (high/low)

  Yes

  No

  N/A

• Park/clearance lights & indicators

  Yes

  No

  N/A

• Taillights/plate lights

  Yes

  No

  N/A

• Brake lights

  Yes

  No

  N/A

• Hazard lights

  Yes

  No

  N/A

Safety Equipment - Confirm that the below items have passed

• Registration

  Yes

  No

  N/A

• Warning triangles

  Yes

  No

  N/A

• Fire extinguishers

  Yes

  No

  N/A

• Spill kit & first aid kit

  Yes

  No

  N/A

• Fluro vest, gloves, hardhat and other required PPE

  Yes

  No

  N/A

Wheels & Tyres - Confirm that the below items have passed

• Rims & tyres

  Yes

  No

  N/A

• Spare wheel

  Yes

  No

  N/A

• I certify that the information I’ve provided above is true and correct. I have the necessary competency to understand all checks/inspections for the items above. I finally confirm I am medically/competently fit to safely perform the respective task(s) following this pre-start.

  Yes

  No

  N/A

• Name

• Date

  Date

• Signature

  Sign