VEDANTA LIMITED, LANJIGARH

vedanta
nsfo rming ehements Integrated Management System

Hywa Inspection Checklist: Gate Entry /Pre Mobilization

Manufacturc & Model Name :
Issue Datc: Rev No. 02
Document No. : VILLIMS/Safcty/VD/005 Version: 01
27.05.2019 Rev Date:27.05.2019
Time: Agency /Transporter Name L 1SqFC
Date 7- 2 Vchicle Rcgistration No: D 3 5 2 1 a
Driver Name:
Kauchansn Vchicle Gate Pass No if any :
NOM
Driver Gate Pass No ifany: 0190 96
Status
PASS (V) Rechecked
OBSERVATIONS FAIL (X) Defect found
Date & sign
Not applicable
(NA)
Valid Driving Liceuse (Hcavy/ Transport
PPEs(Helmet, Reflective Jacket, Safety
Shocs)
3 Tax Validity
4 Insurance Validity
5 Permit Validity
6 Fitness Validity
7 Pollution Under Control Validity
8 Seat belt for allseats
9 No side seat
1 0 |Tyre condition

11 Fronr& Back Hotn

12 Front Light, BackTail &Brake Light
13 Both side Indicators

14Wipers
15 No Ignition Problem

16 Both rear view mirror

17 Brake &Hand brake
18 Body Conditions

19 Vehicle documents copy with vehicle

20 2 nos of wheel chocks

21 Warning Triangle
22 Torch/flashlight, Jack & Tools

23 Reflective tape all sides

24 Fire extinguisher(2 kg DCP)
Sterilized
25First aid kit{Antiseptic cream,
dressing, Plaster, Gauze and bandage)

Vehicle is (Eif Unfit)

Driver Name:
Vehicle Inspector Name TaAon_

Signature Signatur