Monthly Cement Mixer Inspection

Checklist

Form No.: IMS-QK-HSE-3-0057-35

Rev.00
PROJECT:

Contract No.:

Company:

Job No.:

For the Month of

Date of Inspection:

Inspected By:

Additional Comments:

Name and Signature:

Note: This checklist is referenced in procedure number:

IMS-QK-HSE-3-0057

Wheel Condition

Body Ground

Remark
Wiring Installations

Plate No.

Grounding ( Enough length, Tripping

Hazard )

Model

Rotating Parts ( Cover, Grease )

Operator's Name

Body ( Rust, Sharp Edges )

Item
No.

Engine ( leaks, Condition ,

Shelter/Cover )

Inspection Item