Customer Information

  • CRM No:

  • Customer:

  • Crane Location:

  • Add location
  • Service Technicians Name:

  • Crane Model:

  • Serial No:

  • Mileage (miles/kms*) please state which

  • Hours (uw):

  • Hours (s/s)

  • Completed On:

Risk Assessment

  • Have you reported in?

  • Are you aware of the customers site safety rules, emergency procedures and rescue plans if working at height?

  • Are you and the machine in a safe and suitable environment?

  • Are you equiped with the suitable PPE?

  • Do you all the necessary tools/equipment to work safely?

  • Does the activity require the need for Lock Out/Tag Out of the machine or associated parts?
    If YES is answered here, please follow next set of questions.

  • LOTO - What steps have you taken to identify the hazards and stored energey to protect yourself and others from high risk of Serious Injury or Fatality (S.I.F.)?

  • LOTO - What service is being performed that requires Lock Out/Tag Out?

  • LOTO - List the actions that you have taken to the verify the Lock Out/Tag Out of all identified hazardous energy sources.

  • LOTO - Once you have completed the service/maintenance of the machine, what steps have you taken to remove all the Lock Out/Tag Out devices?

  • Are any power tools to be used in a good and safe condition?

  • Are you aware of local environmental procedures for oil spillages, pollution, noise etc?

  • Are you protected from falling objects?

  • Have all precautions been taken to prevent fire, electrocution, burn, drowning, falls, crushing, trapping any other health risks?

  • Is there sufficient natural light/arificial lighting to work safely?

  • If accompanied by visitors, have they been made aware of any relevant risk assessments?

  • Are you or other personnel suitably qualified to operate any of the crane/equipment in use?

  • Is all lifting equipment certified and in test period, is it also suitable for the job?

  • If using hazardous substances, do you have all the relevant safety data sheets and hazardous information?

  • Have you made the customer aware lone working is not permitted?

  • If working at height, is suitable equipment and protection available?

  • If the task involves hot work have specific precautions been taken and fire fighting equipment is located near by?

  • During your risk assessment have you identified any Serious Injury, Life altering or Fatal hazardous conditions?

  • WARNING - If you are not able to answer YES to any of the above questions, PAUSE, ASSESS and RESOLVE the issue with the customer. If this is not possible then escalate this to your relevant supervisor/manager.

  • If you identify any risks/hazards that needs attention please take a photo and include them here

  • Terex Team Member Print Name:

  • Add signature

  • Please either select "Today" or manually input the date and time

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.