Project Information Project Name: Concrete Pump Reg. No: Location: Operators Name: Company Name: Date : Sr. Description Yes No N/A Comments 1. Concrete Pump 3rd Party Certificate & Registration 2. Sonographic test of all pipes 3. Calibration of all the pressure gauges 4. Operator’s Competency Certificate & Driver’s License 5. Safe distance from the edge of the excavation 6. Outrigger pads are free from damage 7. Outriggers are level 8. Reverse alarm and beacon light are operational 9. Whip arrester on the pipes and pump 10. Safe access for concrete mixer to the area (In/Out) 11. Area properly barricaded and signage posted 12. Hydraulic Oil / Diesel Leakage 13. Extension Pipeline - Free from damage 14. Extension Pipeline -Locking pin in every connection 15. Extension Pipeline - Adequately supported & secured 16. Spillage control measure in place 17. Other accessories e.g. spider pacing boom 3rd party certificate 18. Static pumps positioned properly 19. Static pumps – concrete pipes fixed on structure as per design 20. Concrete pipes coupler pins provided 21. Concrete pipes on floor – away from scaffolds/ formworks 22. Competent banks man and supervision provided 23. Others (Specify) Remarks: Inspected By: Signature: Reviewed By HSE Manager / In charge : Signature: Noted by Project Leader Signature:

1. CONCRETE PUMP & EXTENSION PIPELINE
INSPECTION CHECKLIST
Page 1 of 1 Form # HSEQ- CPC (Rev 2 – Mar 23)
Project Information
Project Name: Concrete Pump Reg. No:
Location: Operators Name:
Company Name: Date :
Sr. Description Yes No N/A Comments
1.
Concrete Pump 3rd Party Certificate & Registration
2.
Sonographic test of all pipes
3.
Calibration of all the pressure gauges
4.
Operator’s Competency Certificate & Driver’s License
5.
Safe distance from the edge of the excavation
6.
Outrigger pads are free from damage
7.
Outriggers are level
8.
Reverse alarm and beacon light are operational
9.
Whip arrester on the pipes and pump
10.
Safe access for concrete mixer to the area (In/Out)
11.
Area properly barricaded and signage posted
12.
Hydraulic Oil / Diesel Leakage
13.
Extension Pipeline - Free from damage
14.
Extension Pipeline -Locking pin in every connection
15.
Extension Pipeline - Adequately supported & secured
16.
Spillage control measure in place
17. Other accessories e.g. spider pacing boom 3rd party
certificate
18.
Static pumps positioned properly
19. Static pumps – concrete pipes fixed on structure as
per design
20.
Concrete pipes coupler pins provided
21. Concrete pipes on floor – away from scaffolds/
formworks
22.
Competent banks man and supervision provided
23.
Others (Specify)
Remarks:
Inspected By: Signature:
Reviewed By HSE Manager / In charge : Signature:
Noted by Project Leader Signature: