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12-07-2004 AR-GP-FL
Page 3
NOMBRE :
Operador
NUMERO:
Maquina
Operator / Safety
DATE :
PERCUSION
HORAS:
SHIFT :
Izquierdo :
DIESEL
HORAS :
Derecho :
Carrier / Tramming
POWER PACK
HOURS :
Doc
The operator has the required authorizations and permits and have been fully trained prior
to use the machine
The operator is acquainted with the safety instructions like danger areas, fire prevention,
safety at work, etc.
The operator is acquainted with the service instructions like maintenance, repair and check
instructions
The operator wears the safety devices like earmuffs, eyes protection, helmet, etc.
The operator is acquainted with the operator instructions like machine features, controls,
emergency stop, etc. He has read the operator manual completely.
Boom
Drilling / Bolting
NO
Comments
OM
SM00
SM00
OM
OM
SM07
SM07
SM07
SM02
SM08
SM06
SM06
SM02
OM
SM05
SM04
SM03
SM09
SM10
OM
SM00
OM
SM11
OK
Right :
OM
SM12
Extinguishers : Condition
Electric device
LOCATION :