Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Time on site

  • Job number

  • Hour meter reading

  • Visitor pass number

  • Any other commits

  • Any delays in access to the site

  • Time off site

JOB SAFETY ANALYSIS ( JSA )

  • Work permit number

  • Working at heights

  • Working at heights permit number

  • Controls to be used

  • Harness to be worn when required?

  • Working near live power

  • Controls to be used

  • Traffic and staff in area ?

  • Controls to be used

  • Any other commits

HOIST

  • Chain condition

  • Gypsy gear condition

  • Hook and safety catch

  • Chain Anchor

  • Limit switches

  • Limit Switch Adjustment

  • Motors

  • Air gap

  • Couplings

  • Transmission noise and vibration

  • Mountings

  • Overall Visual Condition. 10= Good. 1= Bad

CROSS TRAVEL

  • Cross travel wheels

  • Overall Wear condition.10= good.1 = bad

  • Transmission noises and vibrations

  • Wear condition. 10= good. 1= bad

  • Couplings

  • Gears and keyways

  • Motors

  • Air gap

  • Oil leaks

  • Mountings

  • Buffers

  • Limit switches and control sensors

ELECTRICAL

  • Collectors

  • Collector shoe condition. 10= good. 1= bad

  • Busbar

  • Busbar signage

  • Contactors

  • Control box

  • Cables and catenary

  • Pendant / radio TX

  • Panel box condition

  • Isolators

  • Isolator signage

  • Tow arm and trolleys

GENERAL ITEMS

  • Signage

  • Compass signage

  • Crows nest / service access

  • Access ladder condition

  • Any comments

  • Inspection technician to sign. All work has been done to comply with the relevant Australian Standards.

  • Customer to sign

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.