ROAD ROLLER - EQUIPMENT CHECKLIST # 006

EQUIPMENT TAG / REG # -________________

Plant / Location: _____________________________________________ Date:______________________ Time: ___________Model / Year:_____________

Contractor Name: ________________________________ Driver Name: __________________________________

Driving License No. __________________________Type:_____________ License Validity:___________________

Other Information:___________________________________________________________________________________________________________________

STATIC CRITICAL RELEVANCE ACCEPTABLE REMARKS

YES / NO
GUARDS ON ROTARY PARTS 
REAR VIEW MIRRORS 
REVERSING ALARM ** 
DIESEL DRIVEN  REQUIRED FOR
HYDROCARBON AREA
STEEL DRUM WHEELS CONDITION  CRITICALITY TO BE
EVALUATED
WIRING  CRITICALITY TO BE
EVALUATED
SPARK ARRESTOR *  REQUIRED FOR
HYDROCARBON AREA
TOW HOOK 
BATTERY TERMINAL WITH COVER 
TYPE / VALIDITY OF DRIVER LICENSE 
ANY OTHER HAZARD IDENTIFIED & EVALUATED  CRITICALITY TO BE
EVALUATED

RUNNING CRITICAL
ACCEPTABLE
REMARKS
RELEVANCE
YES / NO
ABNORMAL SOUND  CRITICALITY TO BE
EVALUATED
VIBRATION  CRITICALITY TO BE
EVALUATED
BRAKES 
LIGHTS  FOR USE IN DARK HOURS

STARTING SYSTEM 
OIL & WATER LEAKS 

NOTE: FOR ROAD ROLLER, AUTOMATIC REVERSE ALARM IS PREFERABLE.

LAGEND
* REQUIRED FOR HYDROCARBON AREA

** AUTOMATIC REVERSE ALARM IS PREFERABLE.

NOTES:

1. Medical & Drug tests requirement will not be applicable on spot hired vehicles < 15 days

OBSERVATIONS AND REMARKS:

Prepare By: Contractor Supervisor Verified by : Approved By : Approved for 15 days only
Contractor Safety supervisor
CSI Approval Date:_________________

Name:_____________________ Name: _______________________Name: _____________________________

VALID UP TO:_______________________

(Except any break down or fault in the equipment)

Signature: Signature:____________________Signature: ______________________

(Rev-04A) Apr, 22 Road Roller EST-301-203-IN-PRO-00006-04