Robe Valley Vehicle Escort Checklist

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• THIS CHECKLIST SHALL BE COMPLETED BY THE ESCORTER AND ESCORTEE EVERY TIME A NEW ROUTE IS UNDERTAKEN. THE ESCORTEE SHALL RETAIN SHEET AND HAND IN TO SUPERVISOR AT END OF SHIFT

Pre-Escort Checklist

• Does the escortee's vehicle have the correct radio channel programmed?

  Yes

  No

• Has the escortee been advised of proposed route to location?

  Yes

  No

• Is the escort aware of the distance they must maintain when following escorter? (record distance).

  Yes

  No

• Has the escortee been made aware of the process of interacting with other equipment in the pit? (e.g. right of way, AHS protocols

  Yes

  No

• Have the hazards outlined below been discussed with the escortee?

  Yes

  No

• Do not proceed until the checklist is completed and signed by both Parties.

HAZARD to be discussed

• 1. LV / HV interaction
  
  Control Measure:
  Front runner explanation/safety bubble/escort LV / HV interaction distance, Pit Permit rules discussion

• 2. LV / HV Visibility
  
  Control Measure:
  Outlines route and stays as close to agreed distance as practice. If condition become too dusty escortee is to contact escorter via radiot to reduce speed.

• 3. Are you aware of Blasting today?
  
  Controle Measure:
  Clear of area for Blast

• 4. if working in AT; has a cable been placed for protection around your Vehicle? Has the location been closed and confirmed with Central and coned off, is there a Front runner equipped vehicle with you in travel mode to protect you?
  
  Control Measure:
  Department working in AT to place their cones out at cable to own work area, place cones out if location is closed, travel bubble to cover work area.

• 5. Escorter and escortee vehicles separated
  
  Control Measure:
  Maintain agreed following distance, explain escort mode function if in AT, call a mayday on pit channel if unsure

By signing this document, you agree to abide by the escorting guidelines discussed for this escort through AHS

ENTRY

• Escorter (Name, Signature& Sign Date)

  Sign

• Escortee (Name, Signature& Sign Date)

  Sign

EXIT

• Escorter (Name, Signature& Sign Date)

  Sign

• Escortee (Name, Signature& Sign Date)

  Sign