Project Information Project Name: Company Name: Location: Date : Plant / Equipment type: Plate No: ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No REAR & BRAKE LIGHT ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No TIRE AIR PRESSURE/ CONDITION ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No WIND SHIELD/WIPER ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Remarks: Operator Name: Signature: Reviewed By HSE Manager / In charge: Signature:

1. OPERATOR PRE - USE SAFETY CHECKLIST
(To be completed on daily basis)
Page 1 of 2 Form # HSEQ- OPUDC (Rev 2 - Sep 22)
COVER ALL & VEST ROTATING LIGHT FIRE EXTINGUISHER
SAFETY SHOES
BRAKE SYSTEM
HARD HAT HEAD LIGHT FUEL TANK
SAFETY GLASS &
GLOVES SEAT BELT
SIDE MIRROR
BOLTS &
NUTS
REVERSING
ALARM HORN
WIND
SHIELD/WIPER
Project Information
Project Name: Company Name:
Location: Date :
Plant / Equipment type: Plate No:
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
REAR & BRAKE LIGHT
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
TIRE AIR PRESSURE/
CONDITION
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
WIND
SHIELD/WIPER ☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
BATTERY

2. OPERATOR PRE - USE SAFETY CHECKLIST
(To be completed on daily basis)
Page 2 of 2 Form # HSEQ- OPUDC (Rev 2 - Sep 22)
Remarks:
Operator Name: Signature:
Reviewed By HSE Manager / In charge: Signature: