Mobile Engines BACKHOE Form: HSE-INSP-0002

Issue No.:

Prestart Checklist Date:

Statement of Operator Competence – Required
Supplier Verification & Engine Details Verify Check CAB Verify Check WARNING DEVICES
Cleanliness Horn
Engine’s Owner: Seat Amber Flashing Beacon
Operator Restraint Reversing Alarm
Address:
Instruments & Labelling
Levers / Controls
WARNING SIGNS (In Cabin)
City/Suburb: Verify Check
Pedals
SEAT BELTS MUST BE WORN
Phone: ROPS AS2294
Windows / Wipers / Washers Verify Check
Verify Check
Engine’s Make: SWL
Rear View Mirrors DANGER – BEWARE OVERHEAD WIRES
& UNDERGROUND SERVICES
Crane Chart
Engine’s Model:
Verify Check Verify Check
Serial No.:
Exhaust
Pivots Verify Check
Signature: Connecting Rods
Engine Guarding
Safety Pins
Date: (no excessive wear)
Verify Check
Verify Check
SWL
Quick Hitch
 Engines to conform to the manufacturer’s specifications and Safety Pins SWL Verify Check
HSE Regs. (where applicable)
 Engine’s Operator is to provide daily check sheets weekly basis Connecting Rods
 Where applicable, Personal Protective Equipment must be worn.
& Safety Pins
 Engine’s Log Book Detailing service history in accordance with Verify Check Hydraulics
Manufacturer’s specifications should be written legibly in
English. Rams
 Contractor must produce proof of competence of operator, e.g., Verify Check
Certificate of Competence, Licence, Detailed Log Book Hoses
Connections Travelling Hitch
(check for excessive
HSE Use Only wear, leaks and creep) Hydraulics Verify Check

Verify Check Verify Check Rams

NOTE: Sign only when all items have been checked
KEEP CLEAR Tyres
Verify Check
Hoses
Engines Check By: (Signs on both sides of vehicle) Wheels Handrails Connections
Brakes Steps (Check for excessive wear,
Position:
Verify Check Park Brake leaks and creep)
Instructions:
Date: / / Stabilisers Verify Box to be ticked by Owner / Supplier / Operator prior to arrival onsite.
Check Box to be ticked after visual inspection by HSE Department

This is to certify that the Engines being supplied conforms to the relevant HSE Legislation, and the requirements as detailed above. HSE Department will assess this Pre-start Checklist to ensure the supplier has verified compliance to HSE Legislative requirements and,
to register the Engines onto the site. The operator will be required to participate in ongoing training and perform work in accordance with the relevant Work Method Statement. Should the Engines be found to not conform to the above, then it will be prevented from
commencing work on the site until the non-compliance is rectified. HSE Management will not reimburse the Owner / Supplier / Contractor for any down / lost time so caused from the non-conformance.

This form does not remove any liability for the Engines supplier to conform with the relevant HSE Legislation.