Terex Assessment - MCC, INC.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PRE - TRIP INSPECTION

• Checks to make sure all lights work properly?

  Yes

  No

  N/A

• Checks tires for any damage?

  Yes

  No

  N/A

• Checks all mirrors for proper alignment?

  Yes

  No

  N/A

• Checks all hand holds, ladders and steps for damage and obstructions?

  Yes

  No

  N/A

• Checks windshield for damage?

  Yes

  No

  N/A

• Checks back up alarm to ensure operation?

  Yes

  No

  N/A

• Checks all fluids?

  Yes

  No

  N/A

• Checks for fluid leaks?

  Yes

  No

  N/A

• Checks if gauges are operating properly?

  Yes

  No

  N/A

• Checks belts and hoses for cracks or wear?

  Yes

  No

  N/A

• Checks operating controls? (hydraulics, steering, transmission, horn)

  Yes

  No

  N/A

• Checks fire extinuisher?

  Yes

  No

  N/A

• Cleans cab out?

  Yes

  No

  N/A

UNDERSTANDING JSA

• Understands JSA and its intended purpose

  Yes

  No

  N/A

• Understands how to fill out a JSA?

  Yes

  No

  N/A

• Understands the elements of the JSA?

  Yes

  No

  N/A

• Understands what to do if the task should change?

  Yes

  No

  N/A

• Understands how to utilize a JSA for toolbox talks?

  Yes

  No

  N/A

• Understands how everyone on the project must sign the JSA?

  Yes

  No

  N/A

OPERATIONAL ASSESSMENT

• Follows posted speed limits per site location?

  Yes

  No

  N/A

• Follows correct traffic patterns?

  Yes

  No

  N/A

• Speed is steady and easy?

  Yes

  No

  N/A

• Yields the right of way to full trucks?

  Yes

  No

  N/A

• Navigates corners safely?

  Yes

  No

  N/A

• Understands and respects the limits of the equipment?

  Yes

  No

  N/A

• Follows loader OPS instructions on load site?

  Yes

  No

  N/A

• Sets parking brake when being loaded?

  Yes

  No

  N/A

• Waits to be fully loaded before releasing parking brake?

  Yes

  No

  N/A

• Checks quarry for proper berms, including the dump site?

  Yes

  No

  N/A

• Dumps in a safe and slow manner?

  Yes

  No

  N/A

• Uses berms properly when stopping?

  Yes

  No

  N/A

• Pays attention to all areas surrounding dump site and when in travel?

  Yes

  No

  N/A

• Communicates properly with other equipment operators on site?

  Yes

  No

  N/A

• Applies brakes slow and steady to reduce abrupt stops?

  Yes

  No

  N/A

• Uses proper PPE when outside the cab of the equipment?

  Yes

  No

  N/A

• Checks dumping site for any cracks or other unsafe conditions?

  Yes

  No

  N/A

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