Title Page
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Site conducted
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Date and Time
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Task
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Conducted on
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Prepared by
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Location
Fit for Work and Fatigue Management
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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?
Vehicle Preoperational Inspection
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2. Has a vehicle specific pre operational inspection been completed?
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3. Has action been taken to correct any critical safety items that were<br>identified? E.g. anti collision detection system, seatbelts, braking systems
Operator Competency
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4. Is the operator authorized and competent to operate this vehicle for this<br>task?
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5. Are seatbelts being worn?
Fundamentally Stable Parking
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6. Is the parked vehicle fundamentally stable, i.e. with no risk of uncontrolled<br>movement?
Positive Communication System
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7. Are communication devices working and appropriate for the task?
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8. Are positive communication protocols understood and followed?
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9. Has positive communication been established before entering the controlled areas?<br>
Segregation
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10. Are segregation controls visible, secure and appropriate for the task?<br>E.g. vehicle/person separation, windrows, parking locations
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11. Are segregation rules being followed?
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12. Has it been confirmed that segregation controls don’t create new risks?
Signage and Demarcation
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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
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14. Are signage and demarcation being followed?
