Mobile Engines BULL DOZER Form: HSE-INSP-0004

Issue No.:

Prestart Checklist Date:

Supplier Verification & Engine Details Verify Check WARNING DEVICES

Verify Check CAB Horn
Engine’s Owner: Amber Flashing Beacon <12T
Cleanliness
Reversing Alarm
Address: Seat Condition OK
Operator Restraint Provided WARNING SIGNS (In Cabin)
Verify Check
City/Suburb: Instruments Operational & Labelled
SEAT BELTS MUST BE WORN
Levers / Controls Operational
Phone: Pedals in Good Condition Verify Check

ROPS AS2294 DANGER – BEWARE OVERHEAD WIRES

Engine’s Brand: & UNDERGROUND SERVICES
Windows / Wipers / Washers
Engines Model: Rear View Mirrors Verify Check
Verify Check Operator Instruction
Exhaust
Serial No.: Rams (available on plant)
Hoses
Signature: Connections Verify Check
(check for excessive wear,
Date: Engine Guarding
leaks and creep)

 Engines to conform to the manufacturer’s specifications and

HSE Engines Regs.
 Engines Operator is to provide daily check sheets a weekly basis
 Where applicable, Personal Protective Equipment must be worn.
 Engines Log Book Detailing service history in accordance with
Manufacturer’s specifications should be written legibly in
English.
 Contractor must produce proof of competence of operator, e.g.,
Certificate of Competence, Licence, Detailed Log Book

HSE Use Only

NOTE: Sign only when all items have been checked Verify Check
Verify Check
Engine’s Check By: Tracks Verify Check
Handrails
Pivots Steps
Position: Pins Tracks Complete
Connections Idlers Adjusted Instructions:
Date: / / Verify Box to be ticked by Owner / Supplier / Operator prior to arrival onsite.
Safety Pins Drivers Free from Leaks
Check Box to be ticked after visual inspection by HSE Department

This is to certify that the Engines being supplied conforms to the relevant HSE Legislation, and the requirements as detailed above. HSE Department will check this Pre-start Checklist to ensure the supplier has verified compliance to HSE Legislative requirements and,
to register the Engines onto the site. The operator will be required to participate in ongoing training and perform work in accordance with the relevant Work Method Statement. Should the plant be found to not conform to the above, then it will be prevented from
commencing work on the site until the non-compliance is rectified. HSE Management will not reimburse the Owner / Supplier / Contractor for any down / lost time so caused from the non-conformance.

This form does not remove any liability for the Engines supplier to conform with the relevant HSE Legislation.