Tasman Power Vehicle Impact On Person CCC

• Site conducted

• Date & Time

  Date

• Task

• Work Area

• Prepared by

Fit for Work and Fatigue Management

• Are you fit for work and able to stay focused on the task? E.g. physical/mental wellbeing, free from the effects of fatigue and/or medication?<br>

  Yes

  No

  N/A

Vehicle Preoperational Inspection

• Have you completed a vehicle specific pre operational inspection?

  Yes

  No

  N/A

• Have any critical safety items identified in the pre operational inspection been corrected? E.g. anti-collision detection system, seatbelts, braking systems

  Yes

  No

  N/A

Operator Competency

• Are you authorised and competent to operate this vehicle for this task?<br>

  Yes

  No

  N/A

• Is your seatbelt being worn?

  Yes

  No

  N/A

Fundamentally Stable Parking

• Is the parked vehicle fundamentally stable i.e. with no risk of uncontrolled movement?<br>

  Yes

  No

  N/A

Positive Communication System

• Is your communication device working and appropriate for the task? E.g. adequate coverage and quantity

  Yes

  No

  N/A

• Has positive communication been established before entering controlled areas?<br>

  Yes

  No

  N/A

Segregation

• Are the segregation controls visible, secure and appropriate for the task? E.g. vehicle/person separation, windrows, parking locations<br>

  Yes

  No

  N/A

• Have you confirmed that segregation controls don’t create new risks?<br>

  Yes

  No

  N/A

Signage and Demarcation

• Are signage and/or demarcation controls visible, secure and appropriate for the task? E.g. pedestrian walkways, crossings, access points and restricted areas

  Yes

  No

  N/A