Form: 63
Loader Safety Checklist
                                                                                     Rev.:00            Date: 21 02 2021
   PJT site:                        Subcontractor:                 Register No.:               Inspection date:
                                                                                                ⑤
                                                                                                                       ③
                     ①                     ⑦ ④                                     ⑥
                                                                                                                     ⑧
                                     ②
  no.     part Item                inspection method               S   S   M T     W TH            inspection photo
                       Use standardized bucket and
   ①      Bucket       connecting part and bucket itself should
                       not have any crack, deform and damage
          Track,      Wheel (tire) should not have any cracks
   ②     wheel (tire) or deformation and has good                                              Bucket             Wheel (tire)
                      connection status
         Operators     Operators Safety Induction Form
   ③     Induction     should be signed by the operator.
         form
          Controller   Controller, clutch and brakes should
   ④      & brake      work fine and seat belt needs to be
                                                                                             Rear view             Controller
                       attached                                                               camera
          Rear view    Rear view mirror needs to be attached
   ⑤      mirror &     properly and alarm device should
          alarm        function normally
          Hydraulic    There shouldn't be problems like
   ⑥      device &     leakage, damage or worn-out on
                                                                                            Alarm device           Hydraulic
          cylinder     hydraulic motor, cylinder, pipe                                                              cylinder
                       Function of headlight, Reverse
   ⑦      Lamp&        Alarm ,Beconlights, taillight, fog lamp
          Alarms       and mars light should work properly
          Counter       Extra weight should not be added and
   ⑧      weight       connection status of fixing bolt & nut
                       should be firm                                                          Lamp           Counter weight
          Other        Side footboard, protection facilities for
   ⑨      safety       driver's seat, limit switch for crash
          device       protection should be in safe condition
                       All screen curtains & view obstructions
                       should be removed operators cabin                                        etc
  ⑩
          Screens
       Inspector's
         opinion
Page 1 of 3                                                                         M3-FST-FOR-HSE00-GEN-000094
                                                                       Form: 63
                            Loader Safety Checklist
                                                          Rev.:00         Date: 21 02 2021
      Inspector     Name:                  (signature)                                       In
      Site Engineer                                                                          ec
Page 2 of 3                                              M3-FST-FOR-HSE00-GEN-000094
                                                   Form: 63
              Loader Safety Checklist
                                        Rev.:00       Date: 21 02 2021
Page 3 of 3                                  M3-FST-FOR-HSE00-GEN-000094