Tasman Power Vehicle Impact on Person CCFV

• Site conducted

• Date and Time

  Date

• Task

• Conducted on

• Prepared by

• Location

Fit for Work and Fatigue Management

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

  Yes

  No

  N/A

Vehicle Preoperational Inspection

• 2. Has a vehicle specific pre operational inspection been completed?

  Yes

  No

  N/A

• 3. Has action been taken to correct any critical safety items that were<br>identified? E.g. anti collision detection system, seatbelts, braking systems

  Yes

  No

  N/A

Operator Competency

• 4. Is the operator authorized and competent to operate this vehicle for this<br>task?

  Yes

  No

  N/A

• 5. Are seatbelts being worn?

  Yes

  No

  N/A

Fundamentally Stable Parking

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

  Yes

  No

  N/A

Positive Communication System

• 7. Are communication devices working and appropriate for the task?

  Yes

  No

  N/A

• 8. Are positive communication protocols understood and followed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Segregation

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

  Yes

  No

  N/A

• 11. Are segregation rules being followed?

  Yes

  No

  N/A

• 12. Has it been confirmed that segregation controls don’t create new risks?

  Yes

  No

  N/A

Signage and Demarcation

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

  Yes

  No

  N/A

• 14. Are signage and demarcation being followed?

  Yes

  No

  N/A