DATE:……/……/2017 PROJECT :………………………………...... PMV:……………………………… DESCRIPTION :………………………………...... Model:……………………………. PLANT #/Reg. :………………………………………… CAPACITY:……………………… SUPPLIER :………………………………...... CONTACT#:……………………… OPERTOR NAME:……………………………………… MB No:……………………………. MOBILE NO : ……………………………………….. LICENSE No:……………………… REMARKS BY SAFETY ENGINEER: REASONS FOR NOT APPROVED: 1. . 2. . 3. . 4. . 5. . DATE:…/……/2017 SIGNATURE OF SAFETY ENG ……………………………………………...... NAME.:………………………………………. MB NO:………………………………………. This form should be submitted to transport department, after checking the Machineries & equipment’s. Equipment Details: Reg. No: ……………………………. Sl. No. Description Yes No N/A Remarks 1 Valid Vehicle Registration (Mulkhiya) 2 Valid Operator driving license 3 Valid third party certification (Machinery / Equipment) 4 Valid third party certification (Lifting Tackles-Mobile crane) 5 Valid third party certification (operator/driver) 6 Physical Condition A. Tires B. Brakes (Including hand brakes) C. Lights- brake, reverse, Indicator D. Electrical connections E. Oil leakage of any sort-hydraulic, brake, lubricant etc.. F. Operator Cabin-Glasses clear from obstruction G. Joint pins, bolt & nuts for physical connections H. Rear view mirror (rear convex mirror for telehandlers) I. Doors J. Horn / Siren K. Safety seat belt L. Revolving light M. Reverse alarm - audible around 5 Mtr. radius N. Fire extinguisher- operational O. Load chart (for telehandlers & Mobile crane) P. Boom radius indicator (for telehandlers & Mobile crane) Q. Boom angle indicator (for telehandlers & Mobile crane) R. Out rigger - Fully extendable condition (for telehandlers & Mobile crane) S. Safe working limit : Green-under SWL, Orange-Reached SWL, Red-Exceeded SWL (for telehandlers & Mobile crane) T. Anti-two block (for mobile crane) U. Limit switch (for mobile crane) V. Control panel in the operators cabin (for mobile crane) 7 Civil Defense Fitness Certificate (for Diesel tankers) 8 Daily check list for the machineries/Equipment 9 Others Status : Reason(s) for not approval: . …... Checked by : Signature: Date : Time: