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CPCS Log Book PDF
CPCS Log Book PDF
24
Section 5 – Validation Check List
Name
and cover with
of yourself here
CPCS
Keep it Safe
King’s Lynn
PO Box 320
Bircham Newton
operator (or equipment user).
2
If found, please return this logbook to CPCS
charged for a replacement if it is lost or damaged.
You must keep this book in a safe place – you may be
D D M M Y Y Y Y
Your logbook is proof of your ongoing experience as a plant
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G: Tracked (blade/shovel) - Up to 20 tonnes - non-operational only
H: Tracked (blade/shovel) - Up to 20 tonnes - loading/unloading
I: Tracked (blade/shovel) - All sizes - non-operational only
J: Tracked (blade/shovel) - All sizes - loading/unloading
K: Wheeled articulated chassis - Up to 15 tonnes - non-operational only
L: Wheeled articulated chassis - Up to 15 tonnes - loading/unloading
M: Wheeled articulated chassis - All sizes - non-operational only
N: Wheeled articulated chassis - All sizes - loading/unloading
O: Wheeled rigid chassis - Up to 15 tonnes - non-operational only
P: Wheeled rigid chassis - Up to 15 tonnes - loading/unloading
Q: Wheeled rigid chassis - All sizes - non-operational only
R: Wheeled rigid chassis - All sizes - loading/unloading
S: Non-operational Ride on Roller
Section 5 – Category and Endorsement Codes
3
Section 5 – Further information
Section 4 – Employment Record
• Validation Checklist
• CPCS Contact Information
• Category and Endorsement Codes
B: Wheeled
B: Wheeled
• What – the category of plant or equipment you used**
Endorsement
– the identification number (ID) for the machine
which could be the registration number, fleet
A: Up to 15 tonnes
A: Up to 15 tonnes
recorded easily. Please use the tabs provided to separate the
A: Non-LGV
A: Tracked
A: Tracked
A: Hook
Who can endorse the operating record?
Each entry must be endorsed by someone who can confirm
your operating experience on that machine or equipment.
They must provide full contact details.
Loader/Securer – non-STGO
Description
Loader Compressor
“Operating hours” means when you used the machine or
Slinger/Signaller
equipment for work. This does not include downtime, for
Mobile Crane
Skip Handler
Lorry Loader
example, when driving a mobile crane or backhoe loader to
Screener
Trencher
Crusher
and from the site or meal breaks.
A37
A39
A40
A41
A42
A43
A44
A45
A46
A47
A48
A49
A50
A56
A57
A58
A59
A60
A61
Appointed Persons/Crane Supervisors can record the type of
lifts they have planned or supervised.
Version 5 May 2015 4 21 Version 5 May 2015
Section 5 – Category and Endorsement Codes Section 1 – Operating Record
Endorsement Declaration
I confirm that the user of this Logbook is experienced in the
B: Self-propelled
1. Preparing the machine or equipment for work, as per
B: Luffing jib
manufacturer’s requirements
B: Tracked
Endorsement
A: Wheeled
Soil/Landfill Compactor
Industrial Forklift Truck
Telescopic Handler
Agricultural Tractor
Motorised Scraper
Skid Steer Loader
Reach Truck
Grader
Hoist
A21
A22
A23
A24
A25
A26
A27
A10
A12
A14
A15
A16
A17
A18
A19
A20
A02
A04
A05
A06
A09
A30
A31
A32
A33
Operating Hours
Start date 0 7 / 0 3 / 1 1 Start date 1 5 / 0 3 / 1 1 CPCS Website: www.citb.co.uk/cpcs
When
End date 1 2 / 0 3 / 1 1 End date 1 9 / 0 3 / 1 1 These sources will be able to provide information on:
Hours 1 4 Cum. 1 4 Hours 2 6 Cum. 4 0 • How do I get a card?
• How do I find a CPCS Test Centre?
Category A59 Category A59
Operating Details
Endorsement A Endorsement A
Mailing Address:
Operator
What
Make/Model JCB JS130 Make/Model JCB JS130
CPCS, PO Box 320, Bircham Newton, King’s Lynn
Norfolk, PE31 6WD
ID Number N1PD L13 ID Number N1PD L13
Site Address Site Address Health, safety and environment test
Plant Training Ltd Back Fill Plenty HS&E Booking number: 0344 994 4488
Operating Location
Trench Lane Muckley Lane
Digger Land Hole Deep
HS&E Website: www.citb.co.uk/hsandetest
Where These sources will be able to provide information on:
Site Postcode Site Postcode
• How do I prepare for the test?
H43 2AU G23 1AB
• How do I book the test?
Name Name CPCS Renewal test
Sam Sample Sarah Sample
Renewal test booking number: 0344 994 4488
Position Position
Renewal test website: www.citb.co.uk/renewaltest
Operating Endorsement
Employer
Site Foreman Site Manager
These sources will be able to provide information on how to:
Signature Signature
• prepare for the CPCS Renewal test
Who
Operating Hours
Start date / / Start date / /
The purpose of this section is to provide you with further
When
information to support you in completion of your logbook. End date / / End date / /
Operating Details
• Validation Checklist
Endorsement Endorsement
What
Make/Model Make/Model
ID Number ID Number
Site Address Site Address
Operating Location
Where
Site Postcode Site Postcode
Name Name
Position Position
Operating Endorsement
Signature Signature
Who
Company Name Company Name
When
When
End date / / End date / / End date / / End date / /
Operating Details
Endorsement Endorsement
What
What
Make/Model Make/Model Job title/duties Job title/duties
ID Number ID Number
Site Address Site Address Employer Address Employer Address
Operating Location
Employer Location
Where
Where
Site Postcode Site Postcode Site Postcode Site Postcode
Employer Endorsement
Operating Endorsement
Who
Who
When
End date / / End date / / which can be countersigned by the Testing Body to confirm
Test Completion.
Total duration Total duration
Nature of business Nature of business
How do I complete this section?
You should fill out this section to record
What
• When – the test date and duration
Job title/duties Job title/duties
• What – details of the test taken, for example:
– HS&E Test passes
– Technical Test passes
Employer Address Employer Address
– Renewal Test Passes
• Where – location of where the test was taken
Employer Location
Where
You should fill in this section after each test that you take
is passed.
Site Postcode Site Postcode
Signature Signature
Who
Test Date
Test date / / Test date / /
When
The purpose of this section is to capture a record of current
Test duration Test duration employment, or any previous employment over the last
few years.
Test Details
change your job.
What
How do I complete this section?
Site Address Site Address You should fill out this section to record the details about your
employment including:
• When – start and finish dates
Test Location
• What – the sectors of industry you worked in (nature
Where
of business) and your duties
• Where – the address where the employer is based
Test Site Postcode Test Site Postcode You should fill in this section on leaving an employer.
Tester Name Tester Name Who can endorse the employment record?
Each entry must be endorsed by the employer to confirm that
Tester Position Tester Position you have worked for them as stated. They must provide full
contact details.
Test Endorsement
Training Date
Training Training
Test Date
/ / / / Test date / / Test date / /
When
When
date date
Training duration Training duration Test duration Test duration
Training Details
Test Details
What
What
Test Site Address Test Site Address Site Address Site Address
Training Location
Test Location
Where
Where
Test Site Postcode Test Site Postcode Test Site Postcode Test Site Postcode
Test Endorsement
Trainer Signature Trainer Signature Tester Signature Tester Signature
Who
Who
Training Provider Name Training Provider Name Test Centre Name Test Centre Name
Training Provider Telephone Training Provider Telephone Test Centre Telephone Test Centre Telephone
Training Date
Training Training
/ / / /
When
The purpose of this section is to capture a record of any date date
training courses, tests or assessments that you have Training duration Training duration
attended or taken.
Training Details
This information could be useful to a new employer if you
change your job.
What
How do I complete this section?
You should fill out this section to record Test Site Address Test Site Address
• When – the training date and duration
• What – details of the training, for example:
Training Location
– All forms of safety training
Where
– First aid training
– Training on additional categories
– LGV driving training
• Where – location of where the training was taken Test Site Postcode Test Site Postcode
You should fill in this section after each training session that
you have completed. Trainer Name Trainer Name
Training Endorsement
Who can endorse the training record?
Each entry must be endorsed by the Trainer to confirm that
you have completed the course. They must provide full Trainer Signature Trainer Signature
Who
contact details.
Training Provider Name Training Provider Name