OCCUPATIONAL HEALTH AND SAFETY ACT, (Act No 85 of 1993)

General Machinery Regulation

REG. 4 (1) An employer / user of machinery shall ensure that every person authorised to operate machinery is fully aware of the
dangers attached thereto and is conversant with the precautionary measures to be taken or observed to obviate such dangers.

REG. 4 No person supervising machinery and no person operating machinery shall, without permission of his superior,
authorise any other person to do his work.

General Duties of Employers to their Employees

Section 8 (2)(i) Ensure that work is performed and that plant or machinery is used under the general supervision of a person
trained to understand the hazards associated with it, and who has the authority to ensure that precautionary measures taken by
the employer are implemented.

I, (Employer) for, (Company)

do hereby appoint, (Employee) as a, Jack hammer Operator

at the following premises / site:

Period: Till End of Project

Duties and Responsibilities

1 Ensure you conduct daily pre-start checks on your equipment.

2 Record the results of the inspection on the document provided.
3 Report deviations to your supervisor immediately upon identifying the problem.
4 Keep the equipment clean and ensure the equipment is cleaned before stopping work.
5 Do not allow unauthorised use of the equipment.
6 Wear the prescribed PPE that has been identified in the risk assessment.

AUTHORISED / DESIGNATED BY:

Signature Designation Date

ACCEPTANCE

I, hereby acknowledge receipt of and accept and understand the

requirements of this appointment.
Signature Designation Date

JACK HAMMER OPERATOR