Form No.

Checklist Rev No.: 1

Roller Date: August 2017

Padfoot And Smooth Drum Page: Page 1 of 1

Contractor Name: Assessor’s Name: Date

Vehicle ID No:

Checks GO No N/A Remarks

GO
Brakes and Park brakes

Steering
Any Oil Leak

Excessive Fume Emissions

Seat Belts & Belts

Roll Cage / ROPS

Hooter and Reverse Hooters

Battery lock out
Tyres and wheel nuts
Drum condition and vibrating action(Where Applicable)
Fire Extinguisher and bracket
Check all Lights in working condition

Rotating lights

Hand rails / Steps

Stop Blocks

Drip Tray

Yellow Reflective tape

Hand rails / Steps

General Plant Condition

Following Inspection of evidence presented, I ………………………………………………………….. herewith confirm the Assessment results to be
representative and correct.

Vehicle

Complying Not complying

……………………………………………………….. ………………………………………
Assessor’s Signature Date

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