Vehicle Inspection Form - EN

FieldWork Form Version : 1.7 Status : Completed

Record ID : 1018527

EHS

Appendix 3-00I

Site TAZA PHASE 1|1074288

Inspected By: SSO 605039065
Inspected By: Signature

Date of Inspection 06-Sep-2022 11:06:03 AM

Name of employee vehicle assigned to: Mohamed Founounou

Instructions

Instructions Acknowledge

1. Is there an eyewash bottle present?

2. Is the access to the equipment free and clear of obstacles?
3. Are there no leaks or damage?
4. Are they within the expiration date?
5. Have materials been used or require replacement?
6. Add comments/discrepancies at the bottom of page if necessary and report to
site EHS?
Instructions Acknowledge

1. Ensure access to extinguishers is not blocked.

2. Turn the fire extinguisher upside down and lightly shake it.
3. Check that the pressure is within the recommended level (needle in the green
zone).
4. Check that the locking pins are intact and the tamper seals are not broken.
5. Check the hoses and nozzles for signs of cracking or dry rot.
6. Check the extinguisher for dents, leaks, rust, chemical deposits or other signs of
abuse/wear.
Instructions Continued Acknowledge

7. Check the inspection tags for previous and required inspections.

8. A finding should be entered for each non-compliance.
Instructions Acknowledge

1. Is a first aid kit present?

2. Is the access to the kit free and clear of obstacles?
3. Do any materials within the kit have expiration dates and if so have any materials
expired?
4. Are all first aid materials and medical equipment clean and ready for use?
5. Have materials been used or require replacement?
6. Add comments/discrepancies at the bottom of page if necessary and report to
site EHS?

Inspection

Monthly Inspection

Vehicle Make: Dacia duster

Model: Dacia duster
Color: Black
Year: 2019
License Plate: 16677 B 7
Month of Inspection: AUG
Registration and plate sticker are current Good
Insurance card is current Good
Fleet fuel card is present NA
Fleet service card is present NA
Accident report checklist is present Good
Seat belts available for each passenger Good
Vehicle equipped with air bags Good
Fire extinguisher Present and inspected to monthly criteria Good
First aid kit Present and inspected to monthly criteria Good
Eyewash kit Present and inspected to a weekly criteria Good
Roadside emergency kit (triangles, vest) available Good
Tires and spare tire(s) in good condition Good
Windshield, windows, mirrors in good condition Good
Body of vehicle in good condition Good
Horn, lights, and signals are all functional Good
Interior and bed of vehicle are clean Good
Wipers functional, wiper fluid sufficient Good
Backup alarm functional and working while in reverse Defects Noted
Comments: Not available
Oil and coolant levels sufficient Good
Wheel chocks available Good
Brakes and emergency brake functional Good
Defroster, heating, air conditioning functional Good
Fuel level sufficient to complete tasks Good
Comments: