Form:
Mobile Plant DRUM ROLLER Issue No.:
Checklist Acceptance Operator Competence Document - Required Date:
Supplier Verification & Plant Details Verify CAB Verify Check WARNING DEVICES
Cleanliness Horn
Plant Owner: Seat Condition OK Reversing Alarm
Operator Restraint Provided
WARNING SIGNS (In Cabin)
Address: Instruments Operational & Labelled Verify Check
Levers / Controls Operational SEAT BELTS MUST BE WORN
City/Suburb: Pedals in Good Condition
Verify Check
ROPS AS2294
DANGER – SAFE WORKING LIMITS ON BATTERS
Phone: Windows / Wipers / Washers
Rear View Mirrors Ratio 4 to 1
Plant Make: Operator Instruction Eg only – As per Manufacturers Specifications
(available on plant)
Plant Model: Verify Check
Serial No.: Locating lock for Verify Check
Low/Neutral/Lower Range
Exhaust
Pad lock provided
Signature:
Warning sign – Hasp must be
Date: locked in position before
operating Verify Check
Engine Guarding
Plant to conform to manufacturer’s specifications and HSE Plant
Regs. Verify Check
Plant Operator is to provide daily checksheets to plant group on a
weekly basis Tyres
Where applicable, Personal Protective Equipment must be worn.
Contractor must produce proof of competence of operator, e.g.,
Wheels
Certificate of Competence, Licence, Detailed Log Book Brakes
Park Brake
HSE Use Only Verify Check
Verify Check Hydraulics Crush Point Hazard Verify Check
Sign displayed both
NOTE: Sign only when all items have been checked Hoses sides Handrails
Connections Steps
Plant Check By: (check for excessive wear,
Position: leaks and creep)
Instructions:
Acceptance: Pass Fail Verify Box to be ticked by Owner / Supplier / Operator prior to arrival onsite.
Check Box to be ticked after visual inspection by HSE Department
Date: / /
This is to certify that the plant being supplied conforms to the relevant HSE Legislation, and the requirements as detailed above. HSE Department will assess this Checklist Acceptance to ensure the supplier has verified compliance to HSE Legislative requirements and,
to register the plant onto the site. The operator will be required to participate in ongoing training and perform work in accordance with the relevant Work Method Statement & JSA. Should the plant be found to not conform to the above, then it will be prevented from
commencing work on the site until the non-compliance is rectified. HSE Management will not reimburse the Owner / Supplier / Contractor for any down / lost time so caused from the non-conformance.
This form does not remove any liability for the plant supplier to conform with the relevant HSE Legislation.
