Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Plant Onsite or Offsite

Equipment

Equipment:

  • Supplier

  • Company Hired From:

  • Plant/serial No:

  • Plant On Hire

  • Date & time:

  • Clock Hours:

  • Photo of the machine (If the site allows)

Plant Inspection

Visual Inspection

  • Front Tyres (Inflation, condition & tread remaining)

  • Comments

  • Mid Axle Tyre (Inflation, condition & tread remaining)

  • Comments

  • Rear Axle Tyre(Inflation, condition & tread remaining)

  • Comments

  • Tracks & Pads (Tension and condition)

  • Comments

  • Windows and Wipers

  • Comments

  • Mirrors - Side, Rear, Front

  • Comments

  • CCTV

  • Comments

  • Flashing Beacon

  • Comments

  • Access Steps and Handrails

  • Comments

  • Body/Shell and Cab condition (inc' Drivers Door)

  • Comments

  • Seat Belt & Seat Condition

  • Comments

  • Reversing Siren, Horn, Lights, Instruments/Gauges

  • Comments

  • Guards for Moving Parts (inc Belts, Rollers, PTO)

  • Comments

  • Anti- Vandal Guards (supplied and adequate)

  • Comments

  • Does the machine have any form of leaks

  • Where is the leak ?

  • Where is the leak ?

  • Comments

  • Accessories/Equipiment. Quickhitch & hoses

  • Comments

  • Fuel Level

  • Comments

  • Ad Blue Level (If Used.)

  • Comments

  • Maintenance Record / Thorough Examination Certificate

  • Where are they kept ?

  • Comments

  • Contact the plant manager

Defects

  • Do you wish to add details of any defects found?

  • Details of defect

  • Image fo defect

Sign Off

  • As per section 6(1) of The Health & Safety at Work Act 1974; PUWER 1998 Reg 5 and 6 and LOLER Reg 9 (3)(b), I the operator confirm that the equipment described has been checked/repaired/serviced in accordance with the manufacturer’s recommendations and incorporates no obvious hazards

  • Full Name

  • Add signature

Supervisor / Site Manager Sign Off

  • I can confirm, that the above person as carried out all checks on the plant and are correct.

  • Full Name

  • Add signature

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