Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Date *Day or Night shift? *DayNightName * tank leaks doing Have you completed a fit for duty check? *YesNoAny symptoms of illness? Selected Value: 1 1 = none at all and 10 = extremely sick How tired are you? Selected Value: 1 1 = Not at all and 10 = extremely tiredAre you under the influence of drugs or alcohol? *NoYesHow fit are you for duty? Selected Value: 1 1 = being the best and 10 = being the worstAre you doing an equipment checklist? *YesNoEquipment *Please SelectTruckExcavatorRollersSkid Steer (Bobcat)Dump TruckUteEquipment *Site Location *Truck Registration *ACS601ACS605ACS244ACS247ACS608ACS609OtherTruck Registration *Truck Trailer Registration *ACS611ACS655ACS242ACS249ACS688ACS699No TrailerOtherTrailer Registration *Brake failure indicators are operational? *YesNoPressure/Vacuum gauges are operational? *YesNoAir tank drain valves are operational? *YesNoTyres are correctly inflated? *YesNoCondition and depth of tyre tread? *Good conditionBad conditionTyre/s will need to be replaced soonWheels are secure? *YesNoPanels and readily visible structures are secure? *YesNoHorn is operational? *YesNoLights, incliding clearance lights are operational? *YesNoReflectors and lenses are present and in good condition? *YesNoNot faded, broken or damaged? Mirrors are present, in good condition, secure and appropriately adjusted? *YesNoWindows are operational? *YesNoWipers and windscreen washers are functioning to ensure a clear forward vision? *YesNoFluid leaking (oil, fuel, water, refrigerant/coolant, hydraulic fluid, brake fluid or other) from the vehicle (excluding condensation from air conditioning or the refrigeration system) *NoYesAfter starting the vehicle ensure no engine or drivetrain warning lights remain illuminated on the instrument panel *YesNoTrailer coupling is secure (if applicable) *YesNoTarps are in good condition? *YesNoHas the truck been greased *YesNoAre there any leaks or damaged hoses? *NoYesTruck Pre-Start Failure *Describe the fault/s?File Upload * Drag & Drop Files, Choose Files to Upload You can upload up to 30 files. Who owns the equipment? *D J M G Pty LtdCoatesKennardsComplete HireBrooksOtherExcavator Model *CATHitachiCAT *315F336D349DHitachi *ZX17-5ZX60-3ZX200-3ZX350-3Roller *Dynapac CC900HAMM 3414Dump Truck *9T SwivelSkid Steer *Kubota SBL95Hours on Vehicle *Odometer *Fuel Level *0 to 1/4 (⛔️ Notify Senior Management⛔️)1/4 to 1/21/2 to 3/43/4 to FullDoes the machine require Ad Blue? *Yes (⛔️ Notify Senior Management⛔️)NoIs the machine greased? *YesNoHave you checked tracks and undercarriage? *YesNoIs the cabin clean and free of any loose objects? *YesNoIs the seatbelt in working order? *YesNoAre all windows and windscreens free of cracks? *YesNoHydraulic oil levels? *Low (⛔️ Notify Senior Management⛔️)MediumHighFile Upload * Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Amber light working? *YesNo (⛔️ Notify Senior Management⛔️)Amber Light * Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Any faults/defect to be reported? *Yes (⛔️ Notify Senior Management⛔️)NoAny fault or defect identified during this daily plant check?Does the machine require immediate repair? *YesNoAre any of these faults safety/environment hazard? *YesNo If YES to either, PARK MACHINE, contact the MANAGER or FOREMAN. Machine SHALL NOT BE USED until MANAGER or his delegate gives clearance for use. Fault Report *Fault Report File Upload * Drag & Drop Files, Choose Files to Upload You can upload up to 10 files. Signature * Clear Signature Submit
