Saudi Binladin Group

TRANSPORT AND HEAVY EQUIPMENT

Document No: SBG‐HSE – 015‐04 Revision: 6

Date Modified: 21‐01‐2018

EQ Type ‫ﻧ ع اﻟﻤﻌﺪة‬ EXCAVATOR Date of inspection ‫ﺗﺎر ــﺦ اﻟﻔﺤﺺ‬

EQ S.N ‫ﻟﻠﻤﻌﺪة‬ ‫اﻟﺮﻗﻢ اﻟ ﺴﻠﺴ‬ Inspection No ‫رﻗﻢ اﻟﻔﺤﺺ‬
Manufacture Company ‫اﻟ ﻛﺔ اﻟﻤﺼﻨﻌﺔ‬ Company ‫اﻟ ﻛﺔ‬
Equipment No ‫رﻗﻢ اﻟﻤﻌﺪة‬ Operator Name ‫إﺳﻢ اﻟﻤﺸﻐﻞ‬
EQ TUV NO ‫رﻗﻢ إﻋﺘﻤﺎد اﻟﻤﻌﺪة‬ Operator TUV NO ‫رﻗﻢ إﻋﺘﻤﺎد اﻟﻤﺸﻐﻞ‬
EQ TUV Exp Date ‫ﺗﺎر ــﺦ إﻧﺘﻬﺎء إﻋﺘﻤﺎد اﻟﻤﻌﺪة‬ OPerator TUV Exp Date ‫ﺗﺎر ــﺦ إﻧﺘﻬﺎء إﻋﺘﻤﺎد اﻟﻤﺸﻐﻞ‬
Comments ‫ﻣﻼﺣﻈﺎت‬ Equipment TUV ‫إﻋﺘﻤﺎد اﻟﻤﻌﺪة‬
1
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Seatbelt ‫ﺣﺰام اﻷﻣﺎن‬

2
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Operator TUV ‫إﻋﺘﻤﺎد اﻟﻤﺸﻐﻞ‬

3
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Bucket Bins ‫ﺑﻨﻮز اﻟ ﻔﺔ‬

4
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Reverse Alarm ‫إﻧﺬار اﻟﺮﺟ ع ﻟﻠﺨﻠﻒ‬

5
N/A No Yes
‫ﻓﺤﺺ ﺧﺮاﻃ ﻢ وﺻﻤﺎﻣﺎت اﻟﻬ ﺪروﻟ ﻚ‬
Comments ‫ﻣﻼﺣﻈﺎت‬
Hose pipe Inspection
6
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Sides Mirrors ‫اﻟﻤﺮا ﺎ اﻟﺠﺎﻧ ﺔ‬

7
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Horn ‫آﻟﺔ اﻟﺘ ﺒ ﻪ‬

8
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Wipers ‫اﻟﻤﺴﺎﺣﺎت‬

9
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Fire Extinguisher ‫ﻃﻔﺎ ﺔ اﻟﺤ ﻖ‬

10
N/A No Yes
‫اﻹﺿﺎءة اﻷﻣﺎﻣ ﺔ واﻟﺨﻠﻔ ﺔ‬
Comments ‫ﻣﻼﺣﻈﺎت‬
Front & Back Lights
11
N/A No Yes
‫ﺑﻨﻮز وﻣﻔﺼﻼت اﻟﺬراع واﻟ ﻔﺔ‬
Comments ‫ﻣﻼﺣﻈﺎت‬
Knob, Hinges For arm and bucket
12
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Oil Leakage ‫ﺗﻬ ﺐ اﻟ ﺖ‬ Comments ‫ﻣﻼﺣﻈﺎت‬ Chain ‫اﻟﺠ ﺮ‬

15 13
N/A No Yes N/A No Yes
‫ﺳﺠﻞ اﻟﺼ ﺎﻧﺔ‬ ‫اﻟﻔﺤﺺ اﻟﻴﻮ ﻟﻠﻤﺸﻐﻞ‬
Comments ‫ﻣﻼﺣﻈﺎت‬ Comments ‫ﻣﻼﺣﻈﺎت‬
Maintenance Log Daily Inspection (Operator)
16 14
N/A No Yes N/A No Yes

Comments : : ‫ﻣﻼﺣﻈﺎت‬

‫اﻟﺘﻮﻗﻴﻊ‬ ‫إﺳﻢ اﻟﻤﺸﻐﻞ‬

Signature Operator Name
‫ﺗﻮﻗ ﻌﻪ‬ ‫ﻣﺴﺆول ﻗﺴﻢ اﻟﻤﻌﺪات‬
‫اﻹﻋﺘﻤﺎد‬

Signature EQ Dep Response

‫ﺗﻮﻗ ﻌﻪ‬ ‫ﻣ ف اﻟﺴﻼﻣﺔ‬
Signature Safety Supervisor
‫ﺗﻮﻗ ﻌﻪ‬ ‫ﻣﻬﻨﺪس اﻟﺴﻼ ﻣﺔ‬
Signature Safety Engineer

In Case The Equipment Excluded Please Reason For Exclusion / / : ‫ﺗﺎر ــﺦ اﻹﺳ ﻌﺎد‬ ‫ﺣﺎل إﺳ ﻌﺎد اﻟﻤﻌﺪة اﻟﺮﺟﺎء ذﻛﺮ ﺳ ﺐ اﻹﺳ ﻌﺎد‬

‫اﻟﻤﺪﻳﺮ اﻟﺘﻨﻔ ﺬي‬ ‫ﻣﺪﻳﺮ اﻟﺴﻼﻣﺔ‬ ‫ﻣﻬﻨﺪس اﻟﺴﻼﻣﺔ‬

‫اﻹﻋﺘﻤﺎد‬

Constructio Manager Safety Manager Safety Engineer

‫ﺗﻮﻗ ﻌﻪ‬ ‫ﺗﻮﻗ ﻌﻪ‬ ‫ﺗﻮﻗ ﻌﻪ‬
Signature Signature Signature

Archive Received Date : / / / / : ‫إﺳﺘﻼم اﻷرﺷ ﻒ ﺑﺘﺎر ــﺦ‬

At The Time Of Inspection, This Equipment Was Safe For Work On The Project ‫وع أﺛﻨﺎء وﻗﺖ اﻟﻔﺤﺺ‬ ‫ﻫﺬە اﻟﻤﻌﺪة آﻣﻨﺔ ﻟﻠﻌﻤﻞ ﺎﻟﻤ‬