lo /fe [2216 sae fram Tae Phangwa_ Assistant Mechanic Pay ma a sae Lekoba Simon Monyai Engineering Driver Code C Raul Francisco. Bila Site Diesel Mechanic Stanley ‘Waters: Site Diesel MechanicEra irsOLD_KPS_SOP_MNT_0O1 Piers s ue Sh ola. elle sue ey MOBILE MACHINERY APPENDIX 4: CTO- BRAKE TEST PROCEDURE Porson Observed Sarat — A Person Observed Signatire Person Observed Coy. Nr /ID* Signature Observer VOL coy neo” | PeAGD| Sianatre Observer Coy. Nr. 10 Signature server oy. N10" Signature ome [cog oar Observer Coy. Nr 11D" Signature Ti Tow hé : Contractor Date 6 SPE S80 ne O64O- Pb :SS ‘Business Unit of ' Observer Ce Rieke tesryorD| Document Number of 7 So Procedure used during Taskis Observed Observation BRAKE TEST AND STEERING PROCEDURE FOR CS aaa ‘TRACKLESS MOBILE MACHINERY — — Primary Fatal Risk Contol Standard aa Vande @ wane | Bose are | Grund | Hazardous | ‘olaton and [Wing at | Ung Saurent Baws | Conte | "Wwaterat” | emt wor | “Hegns | operatons step | TASK TO BE PERFORMED - YES: No | wa | Testing TMM which doesn’t go through the test ramp 4 71 [is the oparair of he TMM wained, compton and eensed 0 operate the machine? 2 [she machine parked in the level ground and engine runing? 4 '3._| Is the of the blade of the loader lifted about 500 mm from the ground? —) 4 Park brake. is itveleased 10 allow the operator toes the service brakes? = | te second gear selected for he loader and revs raised upto 1000 RPM? = @__| Is the fest goar soleced forthe dump Wucks and reve raised to about 1000 RPM? Static brake tat (Testing brakes on the test ramp) 71s the Twi ntioaced wi he mined malral wher ascending the bake fest ramp? 7 [8 [Dd the operator observed if there is no TMM on top ofthe brake test ramp? — 7 ‘9 Die operator apply tbe service brake onthe decine bythe slop sign? = 10_| What happened with the TMM? Did the TMM move forward? =I F17[ Dine operator apply the park brake on the deine by Ue siop Si? 12_[ What happened with the TMM? Did the TMM move forward? 7ee Wee aT BRAKE TEST AND STEERING PROCEDURE FOR TRACKLESS (elmer Te Dynamic brake test (Testing auditable brakes) 73_| Ts the dynamic testing unit set up with the machine number and ready to be used? are applied? Is the auditable brake tested in the secured area where it cannot move when brakes 75 _| Did the Artisan-perform the running test on the unit? 16 [Is the machine to be tested in the allocated brake testing srea? 17 [Does the artisan understand how the dynamic brake test unil work? Un-safe Observation Tick with "XC it applicable ‘Safe Observation ‘System Deviations: ‘Behavioural Deviations: Didnt complete checklist id not complete checklist in UT ‘Dig not conduct JSA id. not conduct pre-use inspector MSDS not availle. Didinotfolew operational plans 'No operational plansin plas Didrnotidentfy all hazards and aks ‘No procedure Noglgent [No proof of competency. Not authorized No proof of training Not folowing procedure ‘Operate ouside the 86006 Not folowing specications Not Licensed PPE nt available Not wearing PPE ‘Other “Tampored wif safely devices Not Applicable ‘Under inuenea af drugs /alcehol ‘Vitaton of requrements ‘Other = ‘Equipment Deviations Teese ona Housekeeping ‘Control of Chernicais Maintenance ‘Controls not as ar requirements ‘No enginesnng approval Controls not unctioning as required ‘No lockout facity 7} ‘Dosign requirements not followed ‘No safety quard ‘Dig not use correct toois/equipment ‘No standards or rules To operate Evectncily exposed ‘Operate outsce its Engineering changes not documented ‘Software /Data [Ergonomics ‘Spillages ‘Unsafe Conditions Improvement Opportunities / Coaching Action Required Responsibility “Target Dateie ries Pi SUP ei ig ele ee uel Ue MOBILE MACHINERY APPENDIX 4: CTO- BRAKE TEST PROCEDURE [room eres (Ghent Beene |Poceetsome | 7 | Berson Obeoved Sterley Heh as Site Fason Observed cay Signatwe | | oosever 1 Lack | |PpAae [Somme | a cag Ne iD Snare aa corover "Cy 1° Sonsre Oeserver i Toy ne 10" Signature = Cop Ne Sone ‘Cont Date Time: ~ a Cepete —_ oe Bia 071507414 Observer na Cae jake tact op ea Naira Pree anette ? Teta Obsared | Soares O10. KP 8, SOP_ MNT. 91 OR TACKLESS MOBILE MACHINERY _Primary Fatal Risk Control Standard Venide EWobie | Exgiosve and] Ground | Hazardous | solalonand [ Woringat | flag Eguipment lasing. | Control | Materal” | Permtto Work | Heights step | TASK TO BE PERFORMED - ves | NO | NA Testing TMM which doesn't go through the test ramp : 1s the operator of the TMM trained, competent and licensed to operate the machine? Ts the machine parked in the level ground and engine running? Is the of the blade of the loader lifted about 500 mm trom the ground? x Park brake, is itreleased to allow the operator to test the service brakes? AA Is second gear selected for the loader and revs raised up to 1000 RPM? ww 1s the first gear Selected for the dump trucks and revs raised to about 1000 RPM? Static brake test (Testing brakes on the test ramp) 7___[is the TMM not foaded with the minéd matoral when ascending the brake test ramp? ‘8 _ [Did the operator observed if there is no TMM on top of the brake test ramp? ‘9. [Did the operator apply the service brake on the deciine by the stop sign?, 10 _| What happened with the TMM? Did the TMM move forward? 1 2 Dig the operator apply the park brake on the decline by the slop sign? ‘What happoned with the TMM? Did the TMM move forward? SSAAPot come ES BRAKE TEST AND STEERING PROCEDURE FOR TRACKLESS Err Celie aan Dynamic brake test (Testing auditable brakes) | 73s ihe dynamic tesing unit setup wih the machine number and ready tobe used? |__| IS the auditable brake tested in the secured area where i cannot move when brakes ‘ate applied? 5 _| Bi the Arisan perform the running test onthe uni? 16 [fs the machine tobe tesied in the allocated brake testing area [a7 Does the artisan understand how the dynamic brake test unt won? - [Garsate Observation “Tick wih if applicable ‘Safe Observation ‘System Deviations: ‘Behavioural Deviations: Did not complete checklist Bid net cemplete checkst A ‘Did not conduct JSA (Did not conduct pre-use inspection MSDS nol avaiable Did not folow operational plans ‘No operations plans in place Did net deni all hazards and Gk ‘No procedure Negigent f Not authorized ‘No proof of waning Not following procodure ‘Operate outside te scope. ‘Nat following specications ‘Operational requirements nl spoctod ‘Noticensed PPE not avalebl Netwearng PPE ‘Other “Tampered with safely Govcos ‘Not Applieabie ‘Under influence of drags / alcohol ‘wotation of requirements ‘other Equipment Deviations ‘Access unsafe Housekeeping ‘Control of Cherrizals ‘Maintenance ‘Contos not as per requirements ‘Contos not funcioning 2s required [No lockout faciy No safety quard ‘No slandards or ules to operate ‘Operate outsice ists ‘Software /Data Spileges Unsafe Conditons Improvement Opportunities / Coaching ResponsibilityCi oa Ne BRAKE TEST AND STEERING PROCEDURE FOR TRACKLESS Cre) APPENDIX 4: CTO- BRAKE TEST PROCEDURE Person Observed awe [goan, [oe | ‘Coy. Nr. 1D" Signature Person Observed Person Observed Coy ND Signature Coy. Ned” |Peqoog| Sionaiwe EZ Observer (oy. Ne/1O" Signature Observer Coy. Nr. /1D* Signature Obsener Coy FOF Sionatwe Observer Coy Ne IB" Signature Contactor Ce4qa(€ | pate CB rofl nun OZZ0~ 4 (a & Re oa B fake. @. ¢ t amp) ‘Document Numiber oF 2 Procedure used during Taskis Observed | Gbsenaton BRAKE TEST AND STEERING PROCEDURE FOR aan TRACKLESS MOBILE MACHINERY | Primary Fatal Risk Control Standard Vande Beaie | Explemveand | Ground Hazardous | [svat ard Equipment iosing | _Contol__| Material | Permit to Work ‘step | TASK TO BE PERFORMED yes | No | N/A Testing TMM which doesn't go through the test ramp 7 [isthe operator of the TMM trained, competent and licensed to operate the machine? 2 _ [Is the machine parked in the level ground and engine running? eZ 3 _| Is the of the blade of the loader litted about 500 mm from the ground? “4 _| Park brake, i it released to allow the operator to test the service brakes? | 8 = 6 1s second gear selected for the loader and revs raised up to 1000 RPM? Ts the fst gear selocied for the dump trucks end revs raised to about 1000 RPM? Static brake test (Testing brakes on the test ramp) 7__|[ Is the TMM not loaded with the mined material when ascending the brake test ramp? ‘B__| Did the operator observed if there is no TMM on top of the brake test ramp? = '9-_| Did the operator apply the service brake on the decline by the stop sign? = = 10_[ What happened with the TMM? Did the TMM move forward? = 11 | Did the operator apply the park brake on the deciine by the stop sign? = 712_| What happened with the TMM? Did the TMM move forward?aac Sarg NR ela elel=e are Rr eli} MOBILE MACHINERY Dynamic brake test (Testing auditable brakes) 73__| Ts the dynamic tosting unit sat up with the machine number and ready to be used? 14 _| ISthe auditable brake tested in the secured area where it cannot move when brakes ‘are applied? 75__| Did the Artisan perform the running test on the unit” 16 [Is the machine to be tested in the allocatad brake testing area? “17 [Does the artisan understand how the dynamic brake test unit work? Unsafe Observation Tick wih if applicable ‘Safe Observation ‘System Deviations ‘Behavioural Deviations ‘Did at complete checkist id not complete checkistn il ‘Did net conduct JSA ‘id not conduct pre-use inspecton, MSDS not avaible ‘ig not follow operational plans 'No operational plans mh place ‘Dig not iGentiy all hazaras and ASKS ‘No procedure: Negigent ‘No proof of compatoncy Not sunerzed No proof of raining Not following procedure ‘Operate outside the scope Not folowing specications ‘Operational requirements not spaced Not Licensed BPE not avaiable Not weaving PPE ‘Ofer “Tempered with ssfaly devices Not Applicabie Unser influence of drugs I aioshal ‘Violation of requirements ‘omer = Equipment Dev ‘Access unsate Housekeeping ‘Cont of Chemicaie ‘Maintenance ‘Controls not as per requirements ‘No engineenng approval ‘Controls not functoning as required ‘No lockout faaity ‘Design requirements not folowed ‘No! [Dis not use correct toelslequipment No slandards or rules 16 Operate Electricity exposed ‘Operate outside nis Engineering changés not documented ‘Software / Data Ergonomics I Spilages. High emissions __ | Tirsate ona Improverent Opportunities / Coaching Responsibility | Target DateCO oat ae Ps ah sua eh olka olor el LU ec) le TeaL eu sake APPENDIX 4: CTO- BRAKE TEST PROCEDURE Person Observed oda te ly [9054s Signatue | Person Observed Coy. Ne 11" Signature Person Observed Coy, Nr. / 10" ‘Signature —_| Observer Ceee. ge) coy NII" FZeXHe¢> | Sanatwe | onsener | Coy. Ne 110" | [ sionawre [7 ‘Observer Coy. Nr. 1D" Signature Observer Coy. Nr. /1D* - ‘Signature ‘Observer Coy. Nr. /1D* ‘Signature | Contractor Leqest_ Date OP ain. wo Business Unit of eg abe ef fonP Procedure used during Taskis Observed Observation. ~ Primary Fatal Risk Control Standard Varide thobte” | Expose ond] Ground’ | Hazardous | solationand | Woningat [Litre Equipment ‘Busteg | Gontol__| Matera! | Permitiowork | Heights _| Operations step | TASK TO BE PERFORMED yes | No NA Testing TMM which doesn't go through the test ramp, Js the operator of the TMM trained, competent and licensed to operate the machine? | Ts the machine parked in the level ground and engine running? a |s the of the blade of the loader Iifted about §00 mm from the ground? Park brake, is it released to allow the operator to test the service brakes? — | I |s second gear selected for the loader and revs raised up to 1000 RPM? Is the first gear selected for the dump trucks and revs raised to about 1000 RPM? Static brake test (Testing brakes on the test ramp) 77 HTsthe Ta not foaded with the mined material when ascending the brake text ramp? 5 Lid the operator observed there is no TMM ontop cf tho brake test rnp? ‘Bid the operator apply the sorvce brake on the decline by the stop sigh? 10 What happened with the TMB? Did the TMM move forward? 7 Did the operator apply the park broke on the decine by the stop SGA? 42_| What happened'wih the TMM? Dia the TMM move forward?1 KFS. SOPH ES Ech -cig Wee sana teres Usteaton irs (se sourTHa2 Eres sa Dynamic brake test (Testing auditable brakes) 13._[ethe dynamic tosing uni setup wih the machine number and ready tbe used? Ts the auditable brake tesied in the secured area where itcannol move when brakes are applied? 75 Did the Arisan perform the running test on the unit? 16 [Is the machine tobe tested in tho allocatod brake tesiing area? 17 |'Boes the artisan understand how the dynamic brake lest unk work? Unsafe Observation “Tick with i applicable Sale Observation. ‘System Deviaions ‘Behavioural Deviations ‘id Tot compote chockist Did not compete checktst in | Didnot conduct JSA ‘Did not conduct pre-use inspecion MSDS not avaible ‘Dis not folow eperatonal plans ‘No operational plans pace ‘ignotiGeniy at hazards anc TS No procedure egigent No procf of competency Not auihoniza No poof of training Nol iolowing procedure, ‘Operate ouside the Scope. Not otowig specricabons ‘Operational requirements not specified Not Licensed PPE not avaiable Not wearing PPE ‘Other “Tampered wih safety Gece Not Applicable Tindar influence af drugs 3icohar \Violston of requirements ‘Ofer — Equipment Deviations ‘Access unsafe Housekeeping Conor of Chemieaie Maintenances ‘Controls nts per requirements No engneenng approval ‘Contos not functioning as required No lockout fay Design requirements not followed No safety quard Did notuse correct folsfequipment No stands or rules 16 operate Elect exposed ‘Operate outside is ‘Engineering changes not documented ‘Software Cala Ergonomics ‘Spilages Tigh emissions ‘Unsate Cendivone - No. Improvement Opportunities Coaching ‘Action Required Responsibilityies Pune Poh sur sah oles t les ae aL eda MOBILE MACHINERY APPENDIX 4: CTO- BRAKE TEST PROCEDURE rwsonorsenns (Aaya Eptlegrrero” [ao6r7 Somme |95, zee Person Observed dy. Nr. 10° Signature Person Observed Coy. Ne /1O* Signature Observer LC) 0K M110" |ROTOO | Slorare Observer oy. Ne 1D" seraue | ( FB Obsener oy. Ne" Signatre Observer Coy. NID" Signetwre ‘Obsener Coy. Nr 10 Signature Sonirecior pe, | Date SG[leNMG WS... 0 |OZ2S PAS Business Unt Observer 16 rocatin | C Joke Shop ‘Document Number of tT T Procedure used Jug Taskis Observed Gbsoration BRAKE TEST AND STEERING PROCEDURE FOR OLD_KPS_SOP_MNT_091 TRACKLESS MOBILE MACHINERY Primary Fatal Risk Control Standard Vehide E Mabie | Exgioave and] Ground | Hazardous | Isolaon and | Woikng at Tieng Equipment Blasting Conta ‘Material | Permitto Work | Heights | _Operatons [ step | TASK TO BE PERFORMED — | yes [no | wa | ‘Testing TMM which doesn’t go through the test ramp 1__ | is the operator of the TMM trained, competent and licensed to operate the machine? [Is the machine parked in the level ground and engine running? ‘3 _| Is the of the blade of the loader lifted about 500 mn from the ground? 4 5 Park brake, s released to allow the operator to test the service brakes? x 1s second gear selected for the loader and revs raised up to 1000 RPM? ww 6 _| [sthe first gear selected for the dump trucks and revs raised to about 1000 RPM? 4 ‘Static brake tast (Testing brakes on the test ramp) 7 Is the TMM not loaded with the mined material when ascending the brake testramp? | —~ [Did the operator observed if there is no TMM on top of the brake test ramp? ‘9 | Did the operator apply the service brake on the decline by the stop sign? | = 10_| What happened with the TMM? Did the TMM move forward? = [Za 2 Did the operator apply the park brake on the decline by the stop sign? ‘What happened with the TMM? Did the TMM move forward?Ii) Set one and eS BRAKE TEST AND STEERING PROCEDURE FOR TRACKLESS eric Dee oin=isk Dynamic brake test (Testing auditable brakes) 13_| Ts the dynamic tesling unl set up with the machine number and ready ta be used? Ts the auditable brake tested in the secured area where it cannot move when brakes 14 are applied? 15_[ Did the Anisan perform the running (eet on the unit? 16 [fs the machine to be tested in the allocated brake testing area? 17 Does the artisan understand how the dynamic brake test unit work? [Gast Observation Tick wih i applicable ale Observation. ‘Systom Devi Behavioural Deviations Diol corp Sestak Did nat complete chostlstin ‘id ngtcondua J5A. Did not conduct pre-use nspecion SOS not avaible ‘id not folow operational plans ‘No operational plans Ce Did not ident a nazaids and sks No procedure Negigent No proof of compatangy — Not autoied No proof ef vaning Tio folowing procedun pera ouside ie op Not olowing specications ‘Operational equrerents not speaiad Not Licensed PPE not avaiable Not wearing PPE, ‘other “Tampered wai safely devices Not Appicabie Uncerinivence of rugs aicoRa ‘otaton of regaroments ‘Ober Equipment Deviations ess unsafe ousekeoping Corivet of Chemica aitenance onvls nol as per rsquremenis To engineering approval onols not unctoning as recirod No Tockoutfachiy Design requements ot owed No ssety guard Did notuse carect olslequipment No standards or rls op aate Etecity exposed ‘Operste ouside tis ‘Engineering enange nol documented ware / Data Ergonomics ‘Spilages High emissions ‘Unsafe Condit Improvement Opportunities / Coaching Responsibility PS Operation Level Borman fovved cop sony oe Hot htSeog ae BRAKE TEST AND STEERING PROCEDURE FOR TRACKLESS Cle aca APPENDIX 4: CTO- BRAKE TEST PROCEDURE ee ee f ri LSet Signature oy, Nr. 1D" Signature ‘coy Ne NO" Signature Do Coe leebsoy wii" | Zpgqoo Saraiwe Coy. Ne TI" Signature Coy. N10 Signature oy. Ne. 10+ ‘Signature Observer Coy, Nr. / 10° Signature Contactor Coat. Date ole Ris aon (Obs -O6 'S3 Business Uait of chavs: 4 _|teraton | tot Document Number cf 2 Procedure used during Task/s Observed Observation BRAKE TEST AND STEERING PROCEDURE FOR aaa TRACKLESS MOBILE MACHINERY “Primary Fatal Risk Control Standard ‘Varide & Mobic | Explosve and | Ground | Hazardous | solatonand | Working at Ting Equipment lasing | _ Control ‘Material | Permit to Work step | TASK TO BE PERFORMED Testing TMM which doesn’t go through the test ramp is the operator ofthe TMM Wained, competent and licensed to operate the machine? 1s the machine parked in the level ground and engine running? ra | the of the blade of the loader Iffed about §00 mm from the ground? = ark brake, is released to allow the operator to test the service brakes? = Is second gear selected for the loader and revs raised up to 1000 RPM? — [s the first gear selected for the dump trucks and revs raised to about 1000 RPM? Static brake test (Testing brakes on the test ramp) Is the TMM not loaded with the mined material when ascending the brake test ramp? | Dia the operator observed there's no TMM on top ofthe brake test ramp? Dil he operator apply tho service brako onthe decline by the stop sign? ‘What happened with the TMM? Did the TMM move forward? ‘Did the operator apply the park brake on the decline by the stop sign? \What happened wih the TMM? Did the TMM move forward? alelslelelw AW PS Operation Les Duce ante snot ye iii coeo mnie ES CURT WP Ua a ele tage ait Cole a) sourna? each cand Dynamic brake test (Testing auditable brakes) 13__|'7s the dynamic testing unit sel up with the machine number and readyto be used? 14 | |S the auditable brake tested in the secured area where it cennot move when brakes are applied? 75_| Did the Anisan perform the running test on the unit? 16 | Is the machine to be tested inthe allocated brake testing area? 47 [Does the artisan understand how the dynamic brake test urit work? Unsale Observation Tick with" itappcable ‘Safe Observation. “System Deviations Behavioural Deviations Didmo complele check ‘id rot complete checklist nA Did nat coMBUEL ISA ‘ed rot ennduel presse inspector MSDS ral naleble ‘id not fotaw operational pans No operational plans i plage ‘Did not gent al heard and aS No procedure Naegigent No root of compte Not aurora ‘No proof waning io folowing procaaare ‘Operate cutse the ope Not following specifications Operational requirements nol specified Not Licensed PPE nol avalabe Not wearing PPE. Other Tempered with safety devises Not Applcabie Under ivivence sf dre 7 Io555 ‘tation of requremerts Oner Equipment Deviations = ‘ecass neato Housekeeping ‘onto of Chemicals Mainenence ‘Conirols not as per requirements. No engineering approval ‘Centos rot funcborng as requred No oaou fay Design requtements nol lomed No safely quatd isnot use cared lolsequipment ‘ho standards ores 16 56716 Eleciily enased Operate oulsde its Engieeting anges nat door Sofware / Osta Ergonomics Spitages Thigh emesis Unsafe Conaons No. Improvement Opportunities / Coaching Responsibility | Target Datela aa Irovuier st a oP Ke RelausaN ogc APPENDIX 3: PLANNED TASK OBSERVATION Porson Observed TeLoge 194 sinus | feca/— Person Observed Coy. ty / ID* Signature Person Observed Coy. N11" Signature Person Observed Coy. Ne. 110" Signature ‘Observer CoML Coy. Nr. / 10" 0908, ‘Signature { Observer Coy. Nr. 1D" Signature ; Observer Coy. Ne 1" Signature ‘Observer Coy. Ne 1D Signature Observer Coy. Ne 10 Signature Contractor Date fo [TE| BiS.0-s40 | O90 - 04% Business Untof Observer Location CWatSlp> ‘Document Number of | Procedure used during ‘Teskls Observed Observation (OLD _KPS_SOP_MNT 020 Moving EME into and out ofthe Workshop Primary Fatal Risk Control Standard _ Tease ieee | Emosre md] Ground | Hazardous | tolalonand | Womngat | —_ Lig Eaupment Mag | Cowat _| ‘new’ | pemtiowox | “Megs | operatens sree | TASK TO BE PERFORMED YES | NO] NA | | Ihe operator ofthe EME waned, conpelant and auhorzedvs move he machine — | _-f |_+ | ino'and out of the workshop? | Ihe parking assistant presen and postoned Saf daring the vere of EME a into end out of the workshop? 3 | Eve contacts evident dung the movement of EME inio and out of the workshop 4 4 [ls te bay batcaded off? 4 5 | Does the parking assistont ake charge of the bay? 4 6 _| Is the workshop door fly open a 7 | Did the EME operator hoot prior to starting the EME S 38_| Did the EME operator hoot tice pric to moving the EME =] [9 [ts the bow clean without cary back? Ft 10_ | ls the parking assistant using a flag while recing tho EME? 4 77_| Is the bay where tho EME is going into workshop clear of al machinery and persons? | _—¢ 12. | How do you manage apply the 4 steps to stoty in your area? 73_| What are your top risks and how do you canto them? iaPremier Rtas ence Eiord Uirsale Observation Tick with°X° iaplicable ‘Sale Observation ‘System Deviations ‘Behavioural Deviations ‘Dt complete checkist Dic nol complete checlst in id not conduct ISA ‘Die nt condvet reuse nspector ‘SDS rot avalabia ‘Die not flow operational pans ib operational plans n soca i not iden al hazards and ks io procedure Neaizent Np yoo of comsalener Not authorzed No ptoal of waining Not fobowtn secede ‘Operate cutee tho Scobe Not folowing specication ‘Operatonal requrements Rot specified Not Liensod PPE nol availabe Nol nearing BPE Oe Tampere wih safety devios Not Acai Under infivence of cre sicobal ‘elaton of requremans ‘Other Ea ie Hoosekessing ‘Control of Chena Maintenance ‘Contos not as er recurerens ‘No engineering appl ‘Controls not unctonin) as required ‘No lockout fay Design eguremeris na folowed ‘No salty guard Die not use correct toolsoqupment No slandardse fes a Opeaie Elechicity exposed Operate ous imts ‘Engheering changes nat documented ‘Sofwate/ Dale ‘Ergonomes Spioges High emissions Unsafe Condiions Improvement Opportunities / Coaching ‘Action Required Responsibiity | Target Date =Oe ager) SSI eV.0 Keke Seg celg APPENDIX 3: PLANNED TASK OBSERVATION |_ Person Observed Ripe no" | 25 5m 1 | Sone Porson Observed Coy. Nr. 110° Signature Porson Observed Coy. NETO Signature Person Observed Coy. Nr. 1D" Signature Observer . Ceegzec| Coy. Ne/10" ZEVeps | Sionerure Observer Coy. Nr. / 0" ‘Signature Observer Coy. Ne 110° Signature Observer Coy. Nr. 1D" Signature Observer Coy. Ne 11D Sionature Time: : Sontacior Date Urea um 1OB 35-906 Business Unit oF Observer Location AKL pp Document Number of 7 Procedure used during Taskls Observes Observation LD KPS_SOP_MNT 020 Moving EME into and out ofthe Workshop —— ~~ Primary Fatal Risk Control Standard — a Vanide Baia] Ergiosie and] Giound | “Hazerdous | _soatonand | Wokrg at | Uline pment Bocing | convo_| ‘weal’ | PemteWer | ‘Moghts | _opestens rep | TASK TO BE PERFORMED ves | No | WA 7 | 18 ie aporaor ofthe EME Woined, Competent and athorzedTo move he machine [| into and out the workshop? 7 [I be parking asian present and posoned af uring he movernent EME [> into ond out ef te workshop? [Eye contact is evident curing the movement of EME into and out ofthe workshop 4. | Isthe bay baricaded off? Ze 5 Does the parking assistant take chat je of the bay? = | Is the workshop door fully open x 7 _| Did the EME operator hoot prior to stating the EME Z| | Bid ine EME operator hoot twice pio to moving the EME ¥ @-_[ ls the bow clean without camry back? = - | 10 | ts the parking assistont using a flog while directing the EME? 4 71_ | Is the bay where the EME Is gong into workshop clear ofall machinery andpersons? | 12 | How do you manage apply the 4 steps to safely in your area? | 13 | What are your top risks and how do you control them?Sill Poe nas) 2 ES BroMieLet el ieee ORKSHC Eine Uivsafe Observation Tick with °X*itappfcable ‘Safe Observation. ‘System Deviations: ‘Behavioural Deviations Binal complete checkist ‘id nol comp ete checkin ‘Bid not conduct JEA ‘Did not conduct pre-ws inspaction ‘MSOS not avaiable ‘id not folow operational pans ‘No operational pans m place Did not denial azards and rks ‘No procedure Negigent ‘No proc of compelenar Not uote No poof of tring Not lowing procedure ‘Operate outside the Scape. Not tllowing specticaions ‘Operational requirements not speciied Not Licensed PPE not avaiable Not wearing PPE ‘Other “Tampered with safe Toisas ‘Not Applicable Under influence of crags lccPol ‘Violation of requirements ‘Other Equipment Devi acess unsate Fiousekeeping ‘Gonitt of Geen Mantenance ‘Gontro's not as perrequirements ‘No engineorng approval Controls not funsioning as required ‘No loccoutfactiy ‘Design requirements not illowed ‘No safety guard Did not use correct toolsequipment ‘No standards or ules to operate Electricity exposed Operate outsice limits Engineering chen ges nol dosumenied Sofware / Data Ergonomics Spitages High emissions Unsafe canaitons Improvement Opportunities / Coachingnee er) Mencia a OL Ketan aN on Cree APPENDIX 3: PLANNED TASK OBSERVATION ker ConbcfS [Cos 2g | Snowe E Porson Observed Person Observed SS | coy. ne. 110" Signature Person Observed Coy. Ne IO Shonature Person Observed Coy Ne ID" Signature Observer ' Coy NEI | Zo _| Sisnate Vie Observer Coy. Ne 1D Signature ‘Observer Coy, Nr. /1D* ‘Signature Observer by. Ni /I* Signature ‘Observer Coy. Nr. 10° Signature Ti Contactor Cepee Date Uftef[e rsa. o— Business Unto Observer a Location Clerks ‘Document Number of Provoure used during Taskls Observed Observation ‘OLD _KPs_SOP_MNT_020 Moving EME nto and out ofthe Workshop _ —___ Primary Fatal Risk Control Standard _ aia Stans Emietve a] Ground | Hazaraous | eoiaionand | Wong at | Uifing eaupmnent Tare” | Cont | “wana” | pemuowan | “Neigh | Operatons ‘sree | TASK TO BE PERFORMED ves [wo | NIA Ts the Operalor of the EME trained, competeni and authorized to move the machine into and out of the workshop? 7 | Isthe parking assistant present and postioned saoly during the movement of EME into and out of the workshop? 3_| Eye contact is evident during the movement of EME into and out of the workshop 4 _[ Is the bay barricaded off? '5 | Does the parking assistant take charge of the bay? 6 _| Is the workshop door fully open 7 8 @ Did the EME operator hoot prior to starting the EME Did the EME operator hoot twice prior to moving the EME Is the bow clean without carry back? 40 | Is the parking assistant using a flag while irecung the EME? 17_| Isthe bay where the EME is going into workshop clear of all machinery and persons? 72_| How do you manage apply the 4 steps to safety in your area? 13 | What are your top risks and how do you control them? HUW UCU SINirr Unsafe Observation Tick wi "Xf apptcable Safe Observation ‘System Deviations ‘Behavioural Deviations ‘Dia compete chechst Did nol complete checkst na Did not conduc JSA Did not conduc re-use speCtoR MSDS no avaible ‘id not tote eperstonal pars No operational pln pace Did role a azards ane ks io procedure ia pot of competency ‘Not suhoded No proofofvsning ‘Not ofowing procedure (Operate ouside the spe ‘Nol folowing specfeations Operational coqurements not speci Not Licensed PPE not avalabe Not wearing PFE ‘Ofer “Tampered ith safey caves Not Appicabie Under infuence of gs / coho Vilaon of equrerens Oner Equipment Deviations: ‘Rezess ueate Housekeeping vl of Chemicals Maintenance ‘Conti nol as per requirements Ko engineeing approval ‘Gonitls rol furctionng as roqured No loaoul fay —[Besignrequrements nat olowed No safely quard (id nol use corect toolsequipneri No standats or es © Operate Electncy exposed Operate outdo ns Ergineorng changes ol documented Softee / Data: Ergororves Spilages Figh emission nsale Condions Improvement Opportunities / Coaching ‘Action Requirene ae) APPENDIX 3: PLANNED TASK OBSERVATION Person Observed ?: agro | 317 Signature — | Fane? Person Observed . Coy. Ne. /10* Signature Person Observed Coy. Nr. /1D* Signature Porson Observed Coy. Ne 710 Sanawe | ‘Observer . Cotte | coy Nr 110" 1c¢)_| Stanotue Observer Coy. Nr Sonawe Obsener oy. Ne" Signature Obsener oy. Nr IO" Signature Observer Coy Wr 10" Sionatre Tine: 7 Contractor cant Date USOC | BR w10 |PUS~TOS Business Uni of Sone. Bee tesotn | (tle Document Nomber of Provoduro used during ‘Taskls Observed Observation OLO_KPS_SOP_MNT_020 Moving EME into and out of the Workshop — ~ primary Fatal Risk Contro! Standard ee Terie EWE] Eigen] Grout | Macadcus | lsdatonand | —Wering at [ultra |_“eioment are” | Sowra | “wee” | permtiower | “wee | operons step | TASK TO BE PERFORMED YES | No | NA + she operator ofthe EWE vai compan’ and aulorzed to move the machine int and out of the workshop? y 7 | s the parking assislant present and postioned sae Gurng the maveront of EME = int and out of he workshop? 73 | Eye contact is evident during the movement of EME into and out of the workshop — 4 | Is tne bey baricaced of 7 5 | Does the parking assistant tke charge of tio bay? A [is tre workshop door fly open 7 7 | Did the EME operator hoot prior to starting the EME 7 7 {| Did the EME operator oot tive porto moving the EME [Is the bow clean without carry back? 70 _| Is the parking assistant using a flag while directing the EME? 11_| Is the bay where the EME Is going into workshoo clear ofall machinery and persons? 12_| How do you manage apply the 4 steps io safety in your area? 13_| Wheat are your top risks and how do you control then? VIN Revalidationcae a ar MOVING EME INTO AND OUT OF THE WORKSHOP Eric} Unsafe Observation Tick with "if applicable: Safe Observation ‘System Deviations ‘Behavioural Devialions ‘Did not complete checkist ‘Dia not compete checkistin hil ‘ig nat conduct ISA ‘Did not conduct pre-use mnspecton MSDS not avalable ‘Did not folow operational plans "No operational plans in pace ‘Did not identify al hazarcs and Ske ‘No procedure ‘Negligent ‘No proof of compete Not authorized ‘No proof of taining ‘ot following procedure ‘Operate outside the scope ‘Operstonsl requirements not specified Net olowg specieatons Notliconsed PPE not available ‘Not wearing PPE ‘Oiner “Tamperes wih safely devices ol Appicabie ‘Under influence of rugs /alconol ‘Voiston of requirements ‘Other Equipment Deviations ‘Access unsafe Housekeeping ‘Cont of Cherricals Maintenance ‘Convols not as per requirements [No engineering approval ‘Contos not functioning as required | [No lockout facly » ‘Design requirements not folowed No safety quarc ‘Did notuse correct toolsfequipment ‘No standards or Fibs 16 Operate Electriiy exposed ‘Operate outside iis. Engineering chang@s nol documented ‘Software /Oaia Ergonomics Spilages High emissions = fe Conaivens Improvement Opportunities / Coaching ‘Action RequiredCiencia) MOVING Ieee venga Eire APPENDIX 3: PLANNED TASK OBSERVATION Person Observed ine Bol Ne/10" | 206 37 _| Signature te | Person Observed Coy. Ne 710" Signature Porson Observed Coy. Ne 1D® Signature Person Observed Coy. Nr. /10" Signature Observer Coy. Nr. /10* Signature Observer Coy, Ne. 1D" Signature Observer Coy, Ne 1D" Signature observer Coy. Ne. 1D" Signature ‘Observer Coy. Nr. /1D* ‘Signature Ti Fae Contactor J. Cobtece| one toftef[6 |r uam (0740-63 Business UAT Observer Lrg inectinpocaton C_ Jolt. Document Number of J Procedure used during Task/s Observed Observation ‘OLD_KPS_SOP_MNT.020 Moving EME into and out ofthe Workshop Primary Faia Risk Control Standard — - Taide & Webi [Exgashe ond | Ground | Hezordous | olaionard | Working at) Uitea Equipment Dosing” | Convel__| ‘Nateral” | Permtw work | —Hetnis | Operatons ‘step | TASK TO BE PERFORMED Yes [NO | NA 1 | Ihe operator he EME ined. compeent and authorized wo move he machine 7 to and out of the workshop? 4} 7 [Ie paking assistant present and posioned safe ding he movement oTEWE |} into and out of he workshop? 3 | Eye contact is evident during the movement of EME into and out of the workshop | 4_| othe bay barricaded of? A 3 _| Does the parking assistant tke charge ofthe bay? ea 6 _| Is the workshop door fully open | | 7__[ Di the EME operator hoot prior to starting the EME 7 8 _| Did the EME operator hoot twice porto moving the EME Z| 9 | Is the bow clean without carry back? ¥ 0 | Is tho parking assistant using a flag while directing the EME? 2 77_| isthe bay where ihe EME Is going into workshop clear of ell machinery and persons? | +12 _| How do you manage apo the 4 sts to safety in your area? 43_| What are your tp risks and how do you control them? aINTO AND OUT ¢ Ener Unveate Observation Tick with "X* if applicable ‘Safe Obeavation ‘Syston: Daviatione: ‘Behavioural Deviations: Did nat complete checklist Did not complete checklst in Al ‘ig net conduct JSA. Did not conduct pre-use inspection. MSDS not avalabie Did not folow operational plans No operational plans a place. Did-not identity all hazards and aks ‘No procedure Negligent No proof of compat No! aulhorzed No proof of tsining Not folowing procedure ‘Operate outside the Sone. ‘Not folowing specficalons ‘Operational requirements nol speciied Not Licensed PPE not avaiable Not wearing PPE ‘Other Tampored with saTety Gevces ‘Not Appicabie Under influence of drugs /aiconol Violation of requirements. other Equipment Daviations Acass uneate usskeeping ‘Consol of Chemicals Maintenance Contos nol as pes requirements No engineering approval Gonivols not unctonng 2s required No lockout facity Design requiremen's not followed No safely guard Did not use correct tools/oquipmert ‘No standards or 6s 1 OperaTe Electricity exposed ‘Operate outsice iis Engineering changes not documented ‘Software /Data Ergonomcs Spllages. igh emissions: Unsafe Conaiton Improvement Opportunites / Coaching