Injury Illness Prevention Plan - Flipbook - Page 166
Health and Safety Program Manual
Teamwrkx
Construction, Inc.
Issue Date: 10/16/23
Revision Date: 10/16/23
Heavy Mobile Equipment Operation
Reference: A-11
APPENDIX A
DAILY HEAVY/MOBILE EQUIPMENT CHECKLIST
Operator: ______________________________________________________________
Vehicle: ________________________________________________________________
Date: __________________________________________________________________
Check: (S) each safe item, (D) each defect, NA for non applicable
S
(1) Seat-Belt
(2) Gauge and Instruments
(3) Light (front and rear)
(4) Horn/Warning Device
(5) Back-Up Signal
6) Brakes (hand and foot)
(7) Steering and Hydraulic controls
(8) Tires and Wheels
(9) Fluid Leaks
(10) Physical Damage?
Recent? (Y/N)
Does it affect safe operation? (Y/N)
(11) Equipment Kill Switch
(12) Window Defrost
(13) Reflectors
(14) Windshield Wipers
(15) Fire Extinguishers
Service Required? (Y/N)
Technician Called? (Y/N)
By Whom?
Date:
Service Performed? (Y/N)
By Whom?
Date:
Lockout/Tagout Required? (Y/N)
Vehicle Back in Service? (Y/N)
Date:
13
D
NA