Completed by *

First Name

Last Name

Person consulted *

First Name

Last Name

Date *

MM

DD

YYYY

1. Is correct P.P.E being worn? *

(Safety footwear, hard hat, Hi-Vis clothing & safety glasses as a minimum)

Yes

No

2. Are walkways/catwalks free from spillage? *

Yes

No

3. Are the weigh bridge approaches well maintained and weighbridge deck/below deck free rom spillage and build up? *

Yes

No

4. Is the lunch room of adequate size? *

(One square metre of clear floor space per person)

Yes

No

5. Is there safe clear access to the lunch room? *

Yes

No

6. Is there a chair with a back for each person? *

Yes

No

7. Is there a table of adequate size? *

Yes

No

8. Is boiling water supplied? *

(E.g. kettle, urn, etc)

Yes

No

9. Is there a sink with hot and cold water to wash dishes? *

Yes

No

10. Is there a supply of clean and cool drinking water? *

(Including cups)

Yes

No

11. Are adequate rubbish bins available? *

Yes

No

12. Are adequate heating and cooling facilities available? *

Yes

No

13. Is there an adequate supply of sunscreen? *

Yes

No

14. Is there a working and clean refrigerator? *

Yes

No

15. Is there a vermin proof cupboard for food and crockery? *

Yes

No

16. Is the lunch room clean and tidy? *

Yes

No

17. Is there a notice board for safety, health and environmental issues? *

Yes

No

18. Are the toilets clean? *

Yes

No

19. Are there adequate toilets? *

Yes

No

20. Is there a separate female toilet and means for the disposal of sanitary towels? *

(Necessary only for sites with female employees)

Yes

No

21. Is hand washing facilities including soap, hand towel and hot and cold water available? *

Yes

No

22. Are there adequate shower(s) available (including the supply of soap, hot and cold water)? *

Yes

No

23. Is there an area for people to get changed? *

Yes

No

24. Are the showers and changing area clean and tidy? *

Yes

No

25. Is the plant lockout and lockout table displayed at the lockout station? *

Yes

No

26. Is there an adequate supply of lockout tags, out of service tags, lockout register, etc? *

Yes

No

27. Are all equipment and conveyors clearly labelled? *

(example “Con 2”)

Yes

No

28. Are guards adequate and in place? *

Yes

No

29. Are all accessible tail and head drums guarded? *

Yes

No

30. Are all accessible return rollers guarded? *

Yes

No

31. Are all trough rollers/idlers that are next to skirt plates guarded? *

Yes

No

32. Are there emergency stop lanyards for all accessible conveyors? *

Yes

No

33. Are footings in good condition? *

Yes

No

34. Is the isolator clearly sign posted to indicate the equipment they are isolating? *

Yes

No

35. Are all guards around drive motors/V-belts and counter weights adequate and in place? *

Yes

No

36. Is there adequate access around the screen? *

Yes

No

37. Are lights, horn, reverse beeper working? *

Yes

No

38. Are the steps and hand rails in good order to allow three points of contact? *

(Including sticker fitted)

Yes

No

39. Is the seat belt in good condition? *

Yes

No

40. Is the cabin clear of dust and dirt? *

Yes

No

41. Have pre-start checks been conducted using a check list? *

Yes

No

42. Are drums adequately stored? (in bunds, no leaks, no soil staining, not over loading storage area) *

Yes

No

43. Is bulk storage of fuels and chemicals adequate? *

(Within bunds, no leaks, no soil staining around discharge area, bunded area not under capacity, contents labelled)

Yes

No

44. Is the integrity of bunds satisfactory? *

(Drain valves closed, bunds clean and dry)

Yes

No

45. Are spill kits available and in good working order? *

Yes

No