Nomor Dokumen : Tanggal Efektif
FORM
w
STM-OHS-FRM-o34 A1 Marctz0z2
Halaman
I of9
'i"l r:ii "
MOBILE EQUIPMENT INSPECTION Nomor Ravisi
0t
Owner I Responsible Company:
Equipment Manufacturer, Model and Description: t <1a4ro {-c(l- V 'L W\-^
Unit / Fleet Number / Vehicle ldentificationr A { t .r - Be ,g.,
Vehicle Registration No:
Projech Vtannl.,^ a^LL kCcr,r 7A") Country: ,tJf 6.
lnspection Location: tfu Cri-s lr-i,, p fr( t t Date: [cf fi4e$<k; zazq
lnspected By: {'<, V -1^ arlt r Time: il " 6,0
ContractorsRepresentative: \",1 lULr\ Position: L{-tL
General
...iir
ts the mobile equipment's are registered and is the registration
cu rrent?
ls a copy of the exploration projects Emergency Response Plan
located in the mobile equipment's cabin?
Are Pre-Start inspectiorrs taking place prior to the mobiie
equipment being used? (Check pre-start book is available and
cu rrent)
Do all mobile equipment receive the preventive maintenance
recommended by the manufacturer
Does modifications to mobile equipment only performed after
formal approval by the manufacturer ?
Brakes tlii
;il}
Are the mobile equipment's brakes functioning correctly?
Does the brake pedal have a rubber/anti slip pad fitted
ls the rrobile equipment's park brake operating effectively?
ls the mobile equipment equipped with a traction control ABS
braking system?
Vehicle ldentification
lD Stickers on both sides of vehicle - Height 200mm & Text width
40mm (max 6 digits & max 4 letters, yellow on black) (Vline Site
Spec)
Has the mobile equipment been fitted with yellow reflective
stripes on both sides of the operator's cabin?
Does the mobile equipment have maximum load and tare
signalling ?
lsolation
Has the mobile equipment been fitted with a lockable isolation
switch?
Print Datel Document Classification Authorlsed Bv Version Number I Date Review Date Page:
23 June 2022 lntemal Use Only Yan Fuadi One i 01 Jan 2022 Years 1of I
Nomor Dokumen :
?
FORM Tanggal Efektif
STM-OHS-FRM.O34 01 Maret 2022
Halaman
2of9
MOBILE EQUIPMENT INSPECTION
Nomor Revisi
01
ls the location of the isolation switch clearly labelled?
Does the isolatiorr switch work effectively? (test)
Has the mobil e equipment driver been issued with a personal
isolation lock?
Are personal danger tags, out of service tags and lnformation
available in the mobile u ment cabin?
Towing & Recovery
fl$
f)noc tho mobile equipment have dedicated recovery pants
fitted?
Ha s the mobile equipment been equipped with a tow point (bar
or rin feeder) and is it in condition?
Has the mobile equipment owner developed a vehicle recovery
man rocedure?
Has the mobile equipment been supplied with an approved
kit?
Load Restraint ,::i
ls the rear of the moblle eguiLrrnents cabin protected by a cai-go
ba rrier?
Are load carried which may move, displace or tip over able to be
tied, secured or contained ? {Except for bulk soil load, which
should be evenl distributed
Has the mobil e equipment been supplied with suitable load
restraints to secure loads transported on the tray of rhe mooiie
ui ment?
Does the mobile equipment have load monitoring systems ?
Does the mobile equipment have fixed load table next to the
erator *Wheel Load Backho Excavators*
Roll Over Protection (ROPS) & Falling Object protections Structure (FOPS)
Has the mobil e equipment been fitted with ROPS - internal or
external {lf fitted must be certified}
*Graders, Scraperq Wheel Loaders,
Backhoes, Excavators &
Bulldozer 6 to 5O Tractors and Off-road trucks*
Has the mobile equipment been fitted with FOpS (tf fitted
-
must be certifled)
*Graders, Scrapers, Wheel
Loaders, Backhoes, Excavators &
Bulldozer 5 to 50 Tractors and Off-road trucks*
Does the Mobi I equipment that used in vegetable clearance and
demolitions with Windshield Protection Grid FOG)?
Does the mobile equipment have tilt angle position indicator
visualand audible ?
Seating
Has each mobile equipment's seat been fitted with a 3-point
seatbelt? * il,lobile equipments & Light vehicle* L {r..*V
Print Date: tn Authorised By Version Number I Date Review Date Paqe:
n lune 2022 Yan Fuadi One / 01 Jan 2022 3 years 2ofg
Nomor Dokumen : Tanggal Efektif:
FORM
w
STM.OHS-FRM.O34 01 MaretZO22
Halaman
3of9
MOBILE EQUIPMENT INSPECTION
Nomor Revisi
01
Has each mobile equipment's seat been fitted with a 2 point
seatbelt as a minimunr ? *Graders, Scrapers, Wheel Loaders,
Backhoes, Excavators*
Are head rests fitted to each of the seats?
ls the driver's seat in good condition and can it be adjusted to
suit the driver?
Cabin Access
Are the mobile equipment cabin access steps (drivers and
passengers) in good condition?
Are handrails fitted which enable the mocile equipment driver to
maintain three points of contact wh:le accessing and exiting the
mobile equipments cabin?
Are there any sign of modifications or change on mobile
equipment's access stairs outside fronr the nranufacturer's
recommendation ?
Does the mobile equipment have escape and landing alternatives
in emergency situations ?
Climate Control
ls the mobile equipments cabin air conditioner operational?
Safety Equipment lij
iiiul
Has the mobile equipment been equipped with a g rgs lry
Powder (ABC) fire extinguisher? Check that a current inspection
tag attached (within 6 months) and that the extingulsher securely (
fitted.
For equipment in which the cabin is
located less than 1,80 m from the
Has automatic fire detection and suppression system available
ground level. a risk analysis must
?
determinate the necessity, or not, of
this control.
Has the mobile equipment been equipped with 2x reflective
vests?
Has the mobile equipment been equipped with a first aid kit and
snake bite kit?
Has the mobiie equipment been equipped with 2x wheel chocks?
Has the mobile eguipment been equipped with 3x reflective
saf,ety triangles and/or Cones ? 7x r^€*j @n<_
Has the mobile equipment been equipped with heavy duty, high
capacity remote jumpstart connectors to eliminate the chance of
cross polarity connections and reduce the likelihood of a battery
explosion when jumpstarting the engine?
Communication
the mobile equipment been equipped with a UHF 2-way
Has
ra d io? @a&^o $f
Print Date: Document Classif icalion Authorised Bv Version Number / Date Review Date Paqe:
23 June 2A22 lntemal Use Onfu Yan Fuadi One I 01 Jan2022 3 years 3ofg
Nomor Dokumen :
FORM Tanggal Efektif
w
STM-OHS.FRM-034 01 Maret2022
Ha,aman
4ofg
. ' i,La ni.rrt ,: l MOBILE EQUIPMENT INSPECTION
Nomor Revisi
o1
Has the mo h il e eq U p me nt been eq ui
v d th a icl e
tracki unit a n d eed telem ?
H AS the mobi le e q ulpm ent d rlve been provid
th a personal
tracke ?
Lighting
Are the m oLrile eq U pment' S head li ghts wire d into t he igniti
on &
o eration a i
Are the m obi e equ pm en t' S h eadl gh ts h gh a nd OW bea m
o rati o n a ?
lf fitted are the mobil e equipment's spotlights fitted and
rational?
Are the mobile equipment's hazard lights operational ?
Are the mobile equipment's indicators operational ?
Are the mobile equipment's brake lights operational ?
Are the mobile equipment's reversing lights operational ?
Are used for night operations andf'or in low visibility conditions
and whenever the standard lightinlg of the equipment is no
efficienr, auxiliary lighting approver d by the manufacturer or
the
ineeri area ?
rf fi tted is th e mo b le eq U pm en t' S flash ng be d CO n operational?
Mi ne st te S
Does the mobile equipment's cabln Iight work?
Windscreen & Wipers
ls the mobile equipments windscreen free frorn damage?
Are the windscreen wipers and washers operational?
Are the mobile equi pment windscreen sun visors in good
cond ition ?
Alarms and Horns
ls an audible reversing alarm fittecj and operational?
ls the horn operational?
Tyres, Rims and Wheel Changing Equipment
Are tyres in i-oadworthy conciition?
Have wheel rrut indicators been fitted?
Print Date: Document Ctassif calioi"- umberi Date
23 Jrsre 2022 Review Date Page:
lnternal Use Onlv Yan Fuadi {
3 years 4 of 9
Nomor Dokumen : Tanggal Efektif:
I
FORM
w
STM.OHS-FRM.O34 01 Maret 2022
Halaman
5of9
MOBILE EQUIPMENT INSPECTION Nomor Revisi
01
Are the wheel rims free of any damage?
Has the mobile equipment been equipped with a serviceable
tack with appropriate SWL labelled?
Has the mobile equipment been equipped with a suitable tool
kit for changing of ryres?
Has the mobile equipment been equipped with a spare wheel?
Does the mobile equipment have tire pressure and
temperature monitoring systems ?
Other
Does the mobiie equipment have anrT obvious water, oil or fuel
I ea ks?
ls the mobile equipments battery secured and the terminals
covered?
Whom
Action Required Due Date Closed Out
Responsible
I
clamT h.s" pio Crrdat" ago) f* u /*/ea cL-ee
2
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alarw ( sua* puta)
1
J
4
baru up I
f.^, t3 rt'/u C)nr.
10
Print Da'te: Document Classmcation Authorised By Version Number / Date Review Date Paqe:
23 June 2422 lnternal Use Only Yan Fuadi 3 vears 5ofg
