VEHICLES FOR RADIOGRAPHY SOURCE TRANSPORTATION - EQUIPMENT CHECKLIST # 002

EQUIPMENT TAG / REG # -______________

Plant / Location: __________________________________________________ Date:______________________ Time: ____________ Model Year:___________

Contractor Name: ________________________________ Driver Name: ____________________________

License No. __________________________License Validity:____________Type:_____________ DDC Card #____________________DDC Validity:___________

Medical Tests Compliance & Validity as per FFT Procedure (Y/N) __________________________

Drug Testing Compliance as per Substance Misuse Control Procedure (Y/N) ____________ Other Information ________________________________________

STATIC CRITICAL RELEVANCE

ACCEPTABLE
REMARKS
YES / NO
DOOR LOCKS 
LIGHTS  FOR USE DURING DARK
HOURS
REAR VIEW MIRRORS 
SIDE VIEW MIRROR 
REVERSE LIGHTS 
BRAKE LIGHTS 
WIPER FUNCTION / CONDITION  DURING RAINY WEATHER

HAND BRAKES 
PETROL DRIVEN  NOT ALLOWED INSIDE
HYDROCARBON AREA
TYRE CONDITION 
SPARE WHEEL 
INDICATORS 
SPARK ARRESTOR  FOR HYDROCARBON AREA
ONLY
DRIVER VALID LICENSE 
TOOL BOX 
SPARK ARRESTOR  FOR HYDROCARBON AREA
ONLY

SEAT BELTS 
VEHICLE GLASSES FREE OF ANY TINTED MATERIAL 
SEAT CONDITION  NOT SAFETY CRITICAL

DRIVE RIGHT  FOR CONTINUOUS USE >5

DAYS
HORN  NOT SAFETY CRITICAL

RADIOACTIV|E MATERIAL LABELS / STICKERS ON VEHICLE 

RUNNING
ACCEPTABLE
CRITICAL RELEVANCE REMARKS
YES / NO
EXHAUST PIPE 
BRAKES 
ABNORMAL SOUND 

OBSERVATIONS AND REMARKS:

Prepare By: Contractor Supervisor Verified by : Approved By : Approved for 15 days only
Contractor Safety supervisor
CSI Approval Date:_________________

Name:_____________________ Name: _______________________ Name: _____________________________

VALID UP TO:_______________________

(Except any break down or fault in the equipment)

Signature:__________________ Signature:____________________ Signature: ______________________

(Rev-04) Feb, 22 Vehicle for Radiography EST-301-203-IN-PRO-00006-04

 Driver Medical & Fitness Test Requirement
TESTING ACCEPTABLE
S No. TEST NAME RELEVANCE REMARKS
DATE YES / NO

1 HEALT QUEST AND PHYSICAL EXAMINATION FORM

2 VISION TESTING (VISIUAL ACUITY, FILED OF VISION; COLOR VISION)

3 FUNDOSCOPY Only for night Driving

4 DRUG TESTING OPIATES & CANNABINOIDS

5 WHISPER TEST

Required if whisper test is

6 AUDIOMETRY
abnormal

Blood & Other tests:

1 RESTING ECG

2 CBC

2 ESR

3 SGPT

4 URIC ACID

5 S. CREATININE

6 LDL & FBS (12 HRS. FASTING IS REQUIRED) - URINE D/R

7 HBA1c Only for Diabetic Patient

8 URINE FOR MICRO ALBUMIN Only for Diabetic Patient

9 PSA Only for 45 yrs & above.

10 RANDOM DRUG TESTING As per UEP guideline

Notes: Other Observations & Remarks:

1. UEP Medical testing protocols to be followed for Health Assesment Periodicity
2. Medical test requirement will not be applicable on spot hired vehicles < 15 days

Prepare By: Contractor Supervisor Verified by : Approved By : Approved for 15 days only
Contractor Safety supervisor
CSI Approval Date:_________________

Name:_____________________ Name: _______________________ Name: _____________________________

VALID UP TO:_______________________

(Except any break down or fault in the equipment)

Signature:_________________ Signature:____________________ Signature: ____________________

(Rev-04) Feb, 22 Vehicle for Radiography EST-301-203-IN-PRO-00006-04