Reference No.

SCL/EHS/CL - 03
STAR CEMENT LIMITED Date of Issue: 25-01-20
Lumshnong, Meghalaya Revision No. 1
CHECK SHEET FOR HYVA Date of Rev. 01-07-22

UNIT/PROJECT: LOCATION: DATE:

19 20 34 27 28 29
15

16

24

1 32
9 30
10 11 23 31
SL NO CHECK ITEMS Y N
1 Vehicle Registration/ Referance No:
2 Driver/Operator - Valid Driving Licence (Transport licence)
3 Operators fitness available (eye test certificate). Last Eye Test dine on
4 Tax valid till
5 Insurance valid till
6 Permit valid till
7 Fitness valid till
8 PUC certificate valid till
9 Head lamps are in good condition for working at night. (Upper / Dipper working)
10 Fog lights are in working condition
11 Left indicator is working / Right indicator is working
12 Parking and brake lights are in working condition
13 Front horn is working.
14 Reverse horn is working.
15 Front view glass is clearly visible / No damage for work.
16 Wipers are in working condition
17 Clutch / brake is in good working condition.
18 Hand / Parking brake is working condition.
19 Back view mirror is available.
20 Cabin is enclosed without any damage.
21 Cabin is clean and tidy.
22 Fire extinguisher in operator cabin is available and working condition.
23 Safe means of access (steps, grab bars, non-slip surfaces) to the cab is provided
24 Engine and others rotating parts are covered.
25 Leakage of oil (in hydraulic & pneumatic systems).
26 Diesel, oil and grease spillage.
27 Vehicle body is enough stable for working
28 Vehicle is clean and tidy
29 Tail door locks / Fasteners are in good condition.
30 Tire conditions are good enough for work.
31 All tire knockoff lug nuts & bolts are available and fitted properly.
32 Mud guards are available and all are in good condition.
33 Wheel chokes are available (minimum two nos).
34 Reflective Tape is pasted on vehicle as per Rule No. 104 of Central Motor Vehicles Rules, 1989.
35 Servicing is maintaining as per schedule.
Comments If any:

Signature of site Safety Incharge Signature of Automobile In-charge Signature of User/Process Owner