Mobile Engines FORKLIFT Form: HSE-INSP-0009

Issue No.:

Prestart Checklist Date:

Supplier Verification & Engine Details Verify Check CAB Verify Check WARNING DEVICES
Cleanliness Horn
Engine’s Owner: Seat Condition OK Amber Flashing Beacon
Operator Restraint Provided Reversing Alarm
Address: Instruments Operational & Labelled
WARNING SIGNS (In Cabin)
Levers / Controls Operational
City/Suburb: Verify Check
Pedals in Good Condition
SEAT BELTS MUST BE WORN
Phone: ROPS AS2294
Windows / Wipers / Washers Verify Check
Engine’s Brand: Rear View Mirrors DANGER – BEWARE OVERHEAD WIRES,
PIPES and SERVICES
Operator Instruction
Engine’s Model: (Available on plant)
Verify Check
Serial No.: Exhaust

Signature: Verify Check

Verify Check Hydraulics
Engine Guarding
Date: Rams
Hoses
Connections
 Engines to conform to the manufacturer’s specifications and (Check for excessive wear,
HSE Engines Regs.
 Engines Operator is to provide daily check sheets on a weekly leaks and creep)
basis
 Where applicable, Personal Protective Equipment must be worn.
 Engines Log Book Detailing service history in accordance with
Manufacturer’s specifications should be written legibly in
English.
 Contractor must produce proof of competence of operator, e.g.,
Certificate of Competence, Licence, Detailed Log Book
Steering Verify Check
HSE Use Only Unions
Rods
NOTE: Sign only when all items have been checked Connections

Engine’s Check By:

Position:
Instructions:
Date: / / Verify Box to be ticked by Owner / Supplier / Operator prior to arrival onsite.
Note: Register if to be used on Public Roads
Check Box to be ticked after visual inspection by HES 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 plant 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.