DAILY PRE-START CHECKLIST FOR MOTOR GRADER

Equipment
Site Name Type of Work
Number
Manufacturer Model Capacity
Year
Date of First Use Date of Inspection
Manufactured

4
1 Operator’s Vision
Head Light

5
Rearview Mirror

2
Frame Condition

6
Step Access

3
Tire
Wheel Assembly 7
Hydraulic Cylinder

9
Tail Light
8
Beacon Light

10
Reverse Alarm
11
Horn
Rearview Camera

12 Certification 14 Oil Leakage 16 Fire Extinguisher 18 Alcohol Test

13 Permit to Work 15 Seat Belt 17 Banksman/Signal Man

Operator (Sig) Const. Team (Sig) HSE Personnel (Sig)

(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes with:  Acceptable;  Unacceptable;  Need Further Check; NA Not Applicable

Form: HDEC-HSE-CE-013 (E)