TEM.MEX.409.004 Utility Terrain Vehicle Compliance Inspection

• Prepared by

• Conducted on

  Date
• Location
  Address

• All Metals Exploration and contractor owned or leased Utility Terrain Vehicles (UTVs) must be inspected and approved prior to commencement of exploration activities.
  The UTVs must meet one of the following 5 Star Ratings: ANCAP, Euro NCAP, Latin NCAP, NHSTA or IIHS.
  This Inspection checklist is applicable for (UTVs) with a maximum capacity of 4 occupants.

• Project name:

• Project Location:

• Estimated commencement date:

  Date

• Estimated duration of use:

• Equipment Owner or Operator:

Vehicle Specific Details

• Vehicle Type:

  Select

• Registration #:

• Call Sign / ID#:

• Vehicle Make & Model:

• Date of Manufacture:

  Date

• Fuel Type:

  Select

• Date of last maintenance:

  Date

• Vehicle Color:

• Odometer/Hour Reading:

• Trailer Maintenance Schedule:

• Trailer Make & Model:

SECTION A - Minimum Vehicle Requirements

• Any vehicle that receives a “Fail” in Section A must be rectified prior to the vehicle being given approval to operate with MEX, with this form being updated accordingly.

• Side protection that prevents occupants limbs leaving the vehicle in the event of a crash

  Pass

  Fail

  N/A

• Tyres (incl. Spare) in good condition, suitable for terrain

  Pass

  Fail

  N/A

• 3 point inertia reel seat belts for all occupants

  Pass

  Fail

  N/A

• Operational head lights, brake lights, signal /indicators

  Pass

  Fail

  N/A

• Horn, windscreen wipers and washers

  Pass

  Fail

  N/A

• Forward facing seats for all occupants

  Pass

  Fail

  N/A

• Rollover protection system (ROPS) fitted by manufacturer and compliant to SAE J2194

  Pass

  Fail

  N/A

• Vehicle maintained in accordance to manufacture guidance

  Pass

  Fail

  N/A

• Clear signage to indicate pay load limits

  Pass

  Fail

  N/A

• Attachment points for securing external cargo

  Pass

  Fail

  N/A

• Tyre changing equipment including 3x emergency road side triangles and pressure gauge

  Pass

  Fail

  N/A

SECTION B – Additional Vehicle Requirements

• A “Fail” in this sections, or where Not Applicable (N/A), must be supported with an explanation and or risk assessment.

• Driver Monitoring System (DMS) with driver identification, speed and journey monitoring

  Yes

  No

  N/A

• Vehicle Medical Kit (based on risk assessment)

  Yes

  No

  N/A

• High Visibility Flag (based on risk assessment)

  Yes

  No

  N/A

• Reversing Alarm (based on risk assessment)

  Yes

  No

  N/A

• Wheel Chocks / Blocks for parking

  Yes

  No

  N/A

• Amber flashing or revolving roof mounted strobe light

  Yes

  No

  N/A

• Safeguards on moving parts

  Yes

  No

  N/A

• Securely mounted fire extinguisher

  Yes

  No

  N/A

• Safe access and egress from operator cabin

  Yes

  No

  N/A

• Additional Spare Tyre (based on risk assessment)

  Yes

  No

  N/A

• Vehicle Recovery Equipment (based on risk assessment)

  Yes

  No

  N/A

• Communication equipment (based on risk assessment)

  Yes

  No

  N/A

• 4WD system for off-road terrain (based on risk assessment)

  Yes

  No

  N/A

• Maximum UTV height clearance label

  Yes

  No

  N/A

• Inclinometer to indicate maximum stability threshold (based on risk assessment)

  Yes

  No

  N/A

• Clearly identified Isolation Point, lockable in the off position

  Yes

  No

  N/A

• Handles, side-doors and nets in place

  Yes

  No

  N/A
SECTION C – Vehicle Modifications (If applicable)

• A “Fail” in all other sections, or where Not Applicable (NA), must be supported with an explanation and or risk assessment
  You can attach a picture of the vehicle if unsure.

• Vehicle fitted with substantial aftermarket modifications have required certifications

  Yes

  No

  N/A

• Comments:

• Pictures:

  Media

Vehicle Compliance

• All vehicles owned or leased by the company or contractor are required to meet the relevant safety system specifications. Where it is determined that these specifications are unable to be complied with, an exemption may be approved Country Exploration Manager.

• THIS VEHICLE MEETS THE MINIMUM REQUIREMENTS

  Yes

  No

• CORRECTIVE ACTIONS REQUIRED

  Yes

  No

• Comments:

Approval section

• I certify that this inspection is accurate and in accordance to MEX UTV Requirements

  Yes

  No

• Submit the form and leave the signing field blank for the Superintendent of Operations to sign/approve the document. The system will send an automated nofitication.

• Superintendent Operations approval:

  Sign