Water Cart Inspection Report

 

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Truck Hazard and Risk Assessment

OWNER/INSPECTION DETAILS

Inspection #[inspection:inspection_number]

[inspection:trailer_info]

Date[inspection:inspection_date]
Provided for [inspection:provided_for]
Vehicle Make & Model[inspection:vehicle_year] [inspection:vehicle_make] [inspection:vehicle_model]  
[inspection:trailer_info]
Registration No.s[inspection:vehicle_registration] [inspection:trailer_registration]
Odometer Reading[inspection:odometer_reading]
Inspection Done at[inspection:inspection_locale]
Assessment Conducted By     
Steersafe Training and Assessment ABN 84 137 032 681    
Scott Haynes    
Certificate IV Training & Assessment TAA40104    
Certificate No 1678    
Phone: 0418 536 870    
 

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CONTENTS

OWNER DETAILS1
ACKNOWLEDGMENT AND AGREEMENT3
RISK MATRIX & HIERARCHY OF CONTROLS4
WATER TRUCK HAZARD & RISK ASSESSMENT5
NOISE ASSESSMENT11
OPERATOR ACKNOWLEDGEMENT12
DISCLAIMER13

 

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AGREEMENT

THIS AGREEMENT is made on [inspection:inspection_date_agreement]

and is made between:

SCOTT HAYNES of Steersafe Training and Assessment, and

[inspection:customer_representative] of [inspection:provided_for]

The owner/operator agrees to engage Scott Haynes to perform Risk Assessment on the basis of agreement to the following disclaimer.

DISCLAIMER

"Mobile Plant" means the mobile plant, vehicle or equipment described in the assessment and inspected by the assessor.

This assessment is based upon information provided to the assessor up until the date of the assessment. If any modification, alteration or addition is made to the mobile plant following that date, this asessment is null and void and cannot be relied upon for any purpose. In particular, this assessment will then provide no assurance that the mobile plant complies with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. The owner and operator of the mobile plant must conduct regular inspections and maintain the mobile plant at regular intervals. If any alteration or addition is made to the mobile plant, such alterations or additions must be recorded in writing and retained by the owner and operator. The mobile plant will then need to be re-assessed.

At all times it is the responsibility of the owner and operator of the mobile plant to maintain the mobile plant according to the Occupational Health and Safety Regulations 2017 and all other applicable legislation and regulations. The assessor is not and shall not be liable for the mobile plant complying with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. This assessment does not pass any responsibility for such compliance to the assessor, and does not in any way exempt the owner and operator from the continuing responsibility for such compliance. The owner and operator agree to indemnify the assessor against all liability of whatever kind in relation to the mobile plant assessed.

This assessment will be conducted by a qualified workplace assessor. This assessment will not be conducted by a qualified mechanic nor a roadworthy assessor, and no responsibility is assumed by the assessor for any mechanical malfunction of the mobile plant nor lack of roadworthiness.

This assessment identifies risks in relation to the mobile plant only, and does not assess risks in relation to the site where the mobile plant is to be used. A job safety and environmental analysis is required to identify such site risks and should be reviewed by the owner and operator prior to commencement of work on site.  

ACKNOWLEDGEMENT AND AGREEMENT

I confirm that I have read and understood the disclaimer and notes set out about and agree with all terms

Name: [inspection:customer_representative]                            

Company/Organization: [inspection:provided_for]		Signed:[inspection:customer_signature]
Date: [inspection:inspection_date] 

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RISK MATRIX

Risk Matrix

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TRUCK HAZARD AND RISK ASSESSMENT

HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. CRUSHING
    Can anyone be crushed by:
(a) material falling off the vehicleH

I

G

H		Bodies/tanks seal and lock[inspection:bodies][inspection:bodies_issues]M

E

D

I

U

M
No foreign material on bodies.[inspection:material][inspection:material_issues]
(b) uncontrolled or unexpected movement of the vehicle or its loadVehicle structurally sound, including subframe, chassis and turntable[inspection:structure][inspection:structure_issues]
Reverse alarm fitted[inspection:reverse][inspection:reverse_issues]
Horn fitted[inspection:horn][inspection:horn_issues]
Decals fitted[inspection:decals][inspection:decals_issues]
Flashing beacon[inspection:flashing_beacon][inspection:flashing_beacon_issues]
Non slip pedals[inspection:nonslip_pedals][inspection:nonslip_pedals_issues]
Mirrors fitted[inspection:mirrors][inspection:mirrors_issues]
Parking brake operational[inspection:brakes][inspection:brakes_issues]
(c) difficulty in slowing, stopping or immobilising the vehicleService brake operational*[inspection:service_brake][inspection:service_brake_issues]
Regular maintenance of vehicle as recorded[inspection:service_maintenance_records][inspection:service_maintenance_records_issues]
(d) the vehicle tipping or rolling overVehicle structurally sound, including subframe, chassis and turntable[inspection:structure][inspection:structure_issues]
(e) being thrown off or under the vehicleDoors fitted[inspection:doors][inspection:doors_issues]
Seat belt fitted[inspection:seatbelt][inspection:seatbelt_issues]
Cabin fully enclosed[inspection:cabin_enclosed][inspection:cabin_enclosed_issues]
(f) being trapped between the vehicle, materials or a fixed structure.H

I

G

H		Reverse alarm fitted[inspection:reverse][inspection:reverse_issues]M

E

D

I

U

M
Horn fitted[inspection:horn][inspection:horn_issues]
Decals fitted[inspection:decals][inspection:decals_issues]
Flashing beacon[inspection:flashing_beacon][inspection:flashing_beacon_issues]
Non slip pedals[inspection:nonslip_pedals][inspection:nonslip_pedals_issues]
Mirrors fitted[inspection:mirrors][inspection:mirrors_issues]
(g) any other factors not mentioned [inspection:crushing_other][inspection:crushing_other_issues]

*Brakes are checked for function, and not for brake adjustment or brake wear. This is solely the responsibility of the owner/operator. [inspection:page_break]

HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. SHEARING
    Can anyone's body parts be cut off or sheared:
(a) between two parts of the truckH

I

G

H		Prop used under tank during service/repairs[inspection:tank_prop][inspection:tank_prop_issues]L

O

W
 
(b) between a parts of the truck and a work piece or structureReverse alarm fitted[inspection:reverse][inspection:reverse_issues]
Horn fitted[inspection:horn][inspection:horn_issues]
(c) any other factors not mentioned [inspection:shearing_other][inspection:shearing_other_issues]
  1. STRIKING           
    Can anyone be struck by moving objects due to:
(a) uncontrolled or unexpected movement of the truck or materialM

E

D

I

U

M		Reverse alarm fitted[inspection:reverse][inspection:reverse_issues]L

O

W
 
Reversing warning decal fitted[inspection:reverse_decal][inspection:reverse_decal_issues]
Flashing beacon[inspection:flashing_beacon][inspection:flashing_beacon_issues]
Horn fitted[inspection:horn][inspection:horn_issues]
Brake lights and indicators[inspection:brake_lights][inspection:brake_lights_issues]
(b) the truck, or parts of the truck disintegratingRegular maintenance of vehicle as recorded[inspection:service_maintenance_records][inspection:service_maintenance_records_issues]
Decals fitted[inspection:decals][inspection:decals_issues]
Vehicle structurally sound, including subframe, chassis and turntable[inspection:structure][inspection:structure_issues]
Guards fitted as required[inspection:striking_guards][inspection:striking_guards_issues]
(c) the mobility of the truckReverse alarm fitted[inspection:reverse][inspection:reverse_issues]
Decals fitted[inspection:decals][inspection:decals_issues]
Flashing beacon[inspection:flashing_beacon][inspection:flashing_beacon_issues]
(d) any other factors not mentioned [inspection:striking_other][inspection:striking_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. ENTANGLEMENT           
    Can anyone be injured by:
(a) hair, clothing or any other items they are wearing or attached to them, become entangled in the moving parts of the truck or materials on the truck?M

E

D

I

U

M		Guards fitted as required[inspection:entanglement_guards][inspection:entanglement_guards_issues]L

O

W
 
Warning decals for moving parts[inspection:entanglement_decals][inspection:entanglement_decals_issues]
(b) any other factors not mentioned [inspection:entanglement_other][inspection:entanglement_other_issues]
  1. CUTTING, STABBING &PUNCTURING           
    Can anyone be injured by:
(a) contact with sharp or moving parts on the truckM

E

D

I

U

M		Guards fitted as required[inspection:cutting_guards][inspection:cutting_guards_issues]L

O

W
 
(b) the truck, or parts of the truck disintegratingRegular maintenance of vehicle as recorded[inspection:service_maintenance_records][inspection:service_maintenance_records_issues]
Vehicle structurally sound, including subframe, chassis and turntable[inspection:structure][inspection:structure_issues]
(c) uncontrolled or unexpected movement of the truck or materialReverse alarm fitted[inspection:reverse][inspection:reverse_issues]
Reversing warning decal fitted[inspection:reverse_decal][inspection:reverse_decal_issues]
Flashing beacon[inspection:flashing_beacon][inspection:flashing_beacon_issues]
Horn fitted[inspection:horn][inspection:horn_issues]
Brake lights and indicators[inspection:brake_lights][inspection:brake_lights_issues]
(d) any other factors not mentioned [inspection:cutting_other][inspection:cutting_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. TRIPPING, SLIPPING OR FALLING
    Can anyone using or in the vicinity of the truck, trip, slip, or fall due to
(a) slippery or uneven work surfacesM

E

D

I

U

M		Non slip steps and work area[inspection:nonslip_work_area][inspection:nonslip_work_area_issues]L

O

W
 
(b) inadequate steps and handrail to enter and exit vehicleNon slip steps and handrail to ensure 3 points of contact to enter and exit vehicle[inspection:nonslip_vehicle][inspection:nonslip_vehicle_issues]
(c) inadequate stairs, steps or ladders to enter and exit bodies
(d) obstacles in the vicinity of the truck. E.g.: oil spillNo visible signs of fluids leaking from vehicle[inspection:no_visible_fluids][inspection:no_visible_fluids_issues]
Tank sealed to prevent material spillage[inspection:tank_seal][inspection:tail_seal_issues]
Foreign materials removed from vicinity of truck[inspection:material_removed][inspection:material_removed_issues]
(e) any other factors not mentioned [inspection:tripping_other][inspection:tripping_other_issues]
  1. ERGONOMIC
    Can anyone be injured by:
(a) badly designed or damaged seatingM

E

D

I

U

M		Driving seat in good condition[inspection:seat_condition][inspection:seat_condition_issues]L

O

W
 
(b) inhibited body posture or the need for excessive effortAdjustable seat position[inspection:seat_adjustable][inspection:seat_adjustable_issues]
Adjustable driving controls[inspection:controls_adjustable][inspection:controls_adjustable_issues]
(c) inadequate lightingAdequate lights in and outside of cabin[inspection:lights][inspection:lights_issues]
(d) unsafe entry and exit pointsNon slip steps and handrail to ensure 3 points of contact to enter and exit vehicle[inspection:nonslip_vehicle][inspection:nonslip_vehicle_issues]
(e) any other factors not mentioned [inspection:ergonomic_other][inspection:ergonomic_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. ELECTRICAL
    Can anyone be injured or burnt from electrical shock by:
(a) exposed and damaged battery or leadsM

E

D

I

U

M		Guards around battery or wiring[inspection:electrical_guards][inspection:electrical_guards_issues]L

O

W
 
Regular maintenance of vehicle as recorded[inspection:service_maintenance_records][inspection:service_maintenance_records_issues]
Decals fitted[inspection:decals][inspection:decals_issues]
(b) the truck contacting live electrical conductorsJSAs on site and spotters when tipping[inspection:jsa_spotters][inspection:jsa_spotters_issues]
Bodies/tanks lowered when in motion[inspection:tank_lowered][inspection:tank_lowered_issues]
(c) damaged electrical wiring, switches or cablesRegular maintenance of vehicle as recorded[inspection:service_maintenance_records][inspection:service_maintenance_records_issues]
(d) any other factors not mentioned [inspection:electrical_other][inspection:electrical_other_issues]
  1. BURNS                                      
    Can anyone be burnt by:
(a) contact with exhaustM

E

D

I

U

M		Guards around exhaust[inspection:exhaust_guards][inspection:exhaust_guards_issues]L

O

W
 
Decals fitted[inspection:decals][inspection:decals_issues]
Exhaust mounted away from easy access[inspection:exhaust_inaccessible][inspection:exhaust_inaccessible_issues]
(b) fire in the truckRegular maintenance of vehicle as recorded[inspection:service_maintenance_records][inspection:service_maintenance_records_issues]
Fire extinguisher supplied in truck[inspection:fire_extinguisher][inspection:fire_extinguisher_issues]
(c) any other factors not mentioned [inspection:burns_other][inspection:burns_other_issues]
  1. HIGH PRESSURE AND EXPLOSION                                      
    Can anyone be injured by:
(a) high pressure fluidM

E

D

I

U

M		Regular maintenance of hydraulic hoses and couplings as recorded[inspection:hydraulic_maintenance][inspection:hydraulic_maintenance_issues]L

O

W
 
(b) explosions caused by gas, vapours, liquids or other substancesAll seals and tanks in good working order[inspection:seals][inspection:seals_issues]
(c) any other factors not mentioned [inspection:pressure_other][inspection:pressure_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. SUFFOCATION/ASPHYXIATION                                    
    Can anyone suffer or become ill from:
(a) lack of oxygen within the truck cabinM

E

D

I

U

M		adequate ventilation (windows)[inspection:ventilation][inspection:ventilation_issues]L

O

W
 
Air conditioning[inspection:aircon][inspection:aircon_issues]
(b) fumes, toxic gases or vapours within the truck cabinExhaust in good operating condition[inspection:exhaust_condition][inspection:exhaust_condition_issues]
Door and window seals in good condition[inspection:door_condition][inspection:door_condition_issues]
(c) dust within the truck cabin
(d) overheating within the truck cabinAdequate ventilation (windows)[inspection:ventilation][inspection:ventilation_issues]
(e) any other factors not mentioned [inspection:suffocation_other][inspection:suffocation_other_issues]
  1. OTHER HAZARDS                                    
    Can anyone be injured or become ill from:
(a) excessive noiseM

E

D

I

U

M		Hearing protection supplied                                   
N.B. See noise level test for more detail		[inspection:hearing_protection][inspection:hearing_protection_issues]L

O

W
 
(b) vibrationExcessive Vibration[inspection:vibration][inspection:vibration_issues]
(c) excessive temperatures in cabinHeater and air conditioner[inspection:heater][inspection:heater_issues]
Adequate ventilation and sealing doors and windows[inspection:ventilation][inspection:ventilation_issues]
(e) any other factors not mentioned [inspection:misc_other][inspection:misc_other_issues]
  1. DOCUMENTATION                                    
    Has information been provided on the following:
(a) daily pre start inspection check listM

E

D

I

U

M		Pre start filled out each day[inspection:daily_check_list][inspection:daily_check_list_issues]L

O

W
 
(b) Service and maintenance recordsService history[inspection:maintenance_records][inspection:maintenance_records_issues]
(c) truck operation manualTruck Manual[inspection:operators_manual][inspection:operators_manual_issues]
(d) suitable licence for operation of the truckValid Licence Provided[inspection:licence_valid][inspection:licence_valid_issues]

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NOISE ASSESSMENT

The noise level reading shall be taken at exhaust level, and within 1050mm of the exhaust emission. The reading will be taken at idle and at “Engine Speed at Maximum Power”. This procedure is in accordance with the Environment Protection (Vehicle Emissions) Regulations 2003.

A further reading shall then be taken from the cabin of the truck.

The sound meter used for this assessment is a Digitech QM-1589, Serial No 10060748 in accordance with the Environment Protection (Vehicle Emissions) Regulations 2003.

Truck Details[inspection:vehicle_year] [inspection:vehicle_make] [inspection:vehicle_model]
Registration No.s[inspection:vehicle_registration]
Background Noise[inspection:background_noise]
Noise in Cabin at Idle[inspection:cabin_idle]
Noise in Cabin at Maximum Power[inspection:cabin_power]
Noise at Idle[inspection:noise_idle]
Noise at Maximum Power[inspection:noise_power]

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OPERATOR ACKNOWLEDGMENT 

Operator to read this risk assessment report and complete and sign below. 

I have read and understood this risk assessment report and confirm that I hold the required qualifications to operate the assessed Truck/Plant equipment.

Operator Full NameOperator QualificationOperator SignatureDate Signed

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

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DISCLAIMER

“Mobile Plant” means the mobile plant, vehicle or equipment described in the assessment and inspected by the assessor.

This assessment is based upon information provided to the assessor up until the date of the assessment. If any modification, alteration or addition is made to the mobile plant following that date, this assessment is null and void and cannot be relied upon for any purpose. In particular, this assessment will then provide no assurance that the mobile plant complies with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. The owner and operator of the mobile plant must conduct regular inspections and maintain the mobile plant at regular intervals. If any alteration or addition is made to the mobile plant, such alterations or additions must be recorded in writing and retained by the owner and operator. The mobile plant will then need to be re-assessed.

At all times it is the responsibility of the owner and operator of the mobile plant to maintain the mobile plant according to the Occupational Health and Safety Regulations 2017 and all other applicable legislation and regulations. The assessor is not and shall not be liable for the mobile plant complying with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. This assessment does not pass any responsibility for such compliance to the assessor, and does not in any way exempt the owner and operator from the continuing responsibility for such compliance. The owner and operator agree to indemnify the assessor against all liability of whatever kind in relation to the mobile plant assessed.

This assessment has been conducted by a qualified workplace assessor. This assessment was not conducted by a qualified mechanic nor a roadworthy assessor, and no responsibility is assumed by the assessor for any mechanical malfunction of the mobile plant nor lack of roadworthiness.

This assessment identifies risks in relation to the mobile plant only, and does not assess risks in relation to the site where the mobile plant is to be used. A job safety and environmental analysis is required to identify such site risks and should be reviewed by the owner and operator prior to commencement of work on site.

ACKNOWLEDGMENT AND ACCEPTANCE

I confirm that I have read and understood the disclaimer and notes set out above and agree with all terms.

I also acknowledge I have received the completed Risk Assessment for the aforementioned Mobile Plant

Name: [inspection:customer_representative]Company/Organisation: [inspection:provided_for]  
Signed: [inspection:customer_signature]Date: [inspection:inspection_date]