Pre-Job Hazard Assessment

Gas Concrete Buggy Pre-Use Inspection Checklist
Operator*

First NameLast Name
Date*

MonthDayYear
Date
Time*

:HourMinutesAM/PM Option
TCF*

FloorsForming
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: