Pre-Job Hazard Assessment

Gas Concrete Buggy Pre-Use Inspection Checklist
Operator *

First Name Last Name
Date *

Month Day Year
Date
Time *

: Hour Minutes AM/PM Option
TCF *

Floors Forming
Project Name *
If Other
Location at Job Site *
Email
Input your email address to receive a copy of this Report.

Make and Model of Concrete Buggy *
Other
Buggy Serial Number *
Ground Type *
Ground Conditions *

Operator has reviewed Concrete Buggy Manual *
CO Detector and Log Book Available *
Route Examined for Hazards *
Fluids Leaking *
Fluid Levels OK *
Tires OK *
Brakes Functional *
Steering Functional *
Dumping Mechanism Functional *
Spotter Needed *
Visual Inspection *

Comments
Signature of Operator

Clear
Should be Empty: