ELEVATING WORK PLATFORM

Form: HSE-INSP-0006
Mobile Engines Issue No.:
Knuckle Boom
Prestart Checklist Date:

Supplier Verification & Engine Details Verify Check WARNING DEVICES Verify Check BASKET
Horn Cleanliness
Engine’s Owner: Amber Flashing Beacon Operator Restraint
Motion Alarms Instruments & Labelling
Address:
Raise & Lower Alarms Levers / Controls
City/Suburb: Out of Level Alarm Pedals
Log Book
Phone: Deadman Switch
Hydraulics Operation Instruction
Verify Check
Engine’s Brand: (available on plant)
Rams Verify Check
Hoses
Engine’s Model: SWL / Crane Chart
Connections
Verify Check
Serial No.: (check for excessive
wear, leaks and creep) WARNING SIGNS (In Cabin) Safety Harness & Lanyard
Verify Check Verify Check
Signature:
Pivots SEAT BELTS MUST BE WORN
Date: Connecting Rods Verify Check
Safety Pins DANGER – BEWARE OVERHEAD WIRES
(no excessive wear) &SERVICES
 Engines to conform to the manufacturer’s specifications and Hydraulics
Verify Check Verify Check
HSE Engines Regs.
 Engines Operator is to provide daily check sheets on a weekly Exhaust
basis
Rams
(if applicable)
 Where applicable, Personal Protective Equipment must be worn. Hoses
 Engines Log Book Detailing service history in accordance with
Manufacturer’s specifications should be written legibly in Verify Check Connections
English. (check for excessive wear,
 Contractor must produce proof of competence of operator, e.g., Levers / Controls Verify Check leaks and creep)
Certificate of Competence, Licence, Detailed Log Book
Engine Guarding

HSE Use Only Verify Check

NOTE: Sign only when all items have been checked Tyres
Wheels
Engine’s Check By: Brakes
Park Brake
Position:
Instructions:
Date: / / Verify Box to be ticked by Owner / Supplier / Operator prior to arrival onsite.
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 assess this Pre-start Checklist to ensure the supplier has verified compliance to 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.