Page 1 of
HSE PROCEDURE
Doc. No. UM-QHSE-HSE-MME
MONITORING MEASUREMENT AND EVALUATION Issue/ Rev
PROCEDURE Date
DOZER INSPECTIN FORM
Plateرقم اللوحة التاريخ
Date
.no Car License تاريخ انتهاء الترخيص
غير ساري : التأمين
valid ساري
Invalid Insurance date
Operator Name اسم المشغل
License تاريخ إنتهاء الرخصة Driving license رخصة القيادة
Expiry Date Odometer Reading قراءة العداد
From the Ground
Satisfactory
NO Item
Yes No
1 Blade Cutting Edge, Moldboard
2 Blade Tilt Cylinders
3 Pusharm, Trunnion
4 Underneath Of Machine
5 Overall Undercarriage
6 Idlers & Rollers
7 Drive Sprockets
8 Track Assembly
9 Ripper
10 Ripper Shank, GET
11 Steps And Handholds
12
Overall Machine
Engine Compartment
13 Engine Oil
14 Transmission Oil
15 Engine Coolant
16 Air Filter
17 Radiator
18 All Hoses
19 All Belts
20 Overall Engine Compartment
On the Machine, Outside the Cab
21 Fuel Tank
22 Hydraulic Oil Tank
23 Fire Extinguisher
24 Windshield Wipers & Washers
25 Pivot Shaft
26 Batteries & Hold Downs
Inside the Cab
27 ROPS
28 Seat
29 Seat Belt & Mounting
30 Horn, backup alarm, lights
31 Overall Cab Interior
Page 2 of
HSE PROCEDURE
Doc. No. UM-QHSE-HSE-MME
MONITORING MEASUREMENT AND EVALUATION Issue/ Rev
PROCEDURE Date
DOZER INSPECTIN FORM
Additional Comments:
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التوقيع مشرف الصيانة
Sign Maintenance Supervisor
مشرف الجودة و
التوقيع السالمة
Sign QHSE Supervisor