Title Page
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Job Type
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Asset Owner
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Machine Type
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Asset Number/Rego
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WGTP Induction Number
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Conducted on
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Prepared by
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Location
Pre-Start Safety Card
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Are there any adjacent activities that may Impact on safety in the work zone?
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Please list the Hazard and the Control for the Activity.
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Does the Task involve any Safety Essentials? (If so Review and understand the Safety Essential.)
- No
- Working at Heights
- Working with Live Services
- Working in and around Mobile Plant
- Working with Temporary Works
- Electrical Work
- Working near live traffic
- Mobile cranes and lifting operations
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Have you reviewed and understood the safety essential?
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Does the task deal with Stored energy types?
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Please list the Stored energy type and the controls in place to deal with the energy.
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Does the task deal with any other hazards that are not addressed in the SWMS or Work instruction? (E.G. Inclement weather, slippery or unstable surfaces, chemicals, crush points, etc.)
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Please list the Hazard and the control for the hazard.
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Is there additional PPE required for this task?
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Please list extra PPE required
Job Card
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Job completed?
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If possible take Photos of the job or repairs completed
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Are any replacement parts required to be ordered?
Sign Off
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Is the Machine safe for use?
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Completed by
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Required Repairs Work Order Number
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Supervisor Sign Off ____________________________________________________________________Date______________________________________
