Saudi Binladin Group

TRANSPORT AND HEAVY EQUIPMENT
Document No: SBG‐HSE – 015‐08                                                         Revision: 6

Date Modified: 21‐01‐2018

EQ Type ‫اﻟﻤﻌﺪة‬ ‫ﻧ ع‬ ROLLER COMPACTOR Date of inspection  ‫اﻟﻔﺤﺺ‬ ‫ﺗﺎر ــﺦ‬

EQ  S.N ‫ﻟﻠﻤﻌﺪة‬  ‫اﻟ ﺴﻠﺴ‬ ‫اﻟﺮﻗﻢ‬  Inspection No ‫اﻟﻔﺤﺺ‬ ‫رﻗﻢ‬
Manufacture Company ‫اﻟﻤﺼﻨﻌﺔ‬ ‫اﻟ ﻛﺔ‬ Company ‫اﻟ ﻛﺔ‬
Equipment No  ‫اﻟﻤﻌﺪة‬ ‫رﻗﻢ‬ Operator Name ‫اﻟﻤﺸﻐﻞ‬ ‫إﺳﻢ‬
EQ TUV NO  ‫اﻟﻤﻌﺪة‬ ‫إﻋﺘﻤﺎد‬ ‫رﻗﻢ‬ Operator TUV NO ‫اﻟﻤﺸﻐﻞ‬ ‫إﻋﺘﻤﺎد‬ ‫رﻗﻢ‬
EQ TUV Exp Date ‫اﻟﻤﻌﺪة‬ ‫إﻋﺘﻤﺎد‬ ‫إﻧﺘﻬﺎء‬ ‫ﺗﺎر ــﺦ‬ OPerator TUV Exp Date ‫اﻟﻤﺸﻐﻞ‬ ‫إﻋﺘﻤﺎد‬  ‫إﻧﺘﻬﺎء‬ ‫ﺗﺎر ــﺦ‬
Comments ‫ﻣﻼﺣﻈﺎت‬ Equipment TUV          ‫اﻟﻤﻌﺪة‬ ‫إﻋﺘﻤﺎد‬
1
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Seatbelt                           ‫اﻷﻣﺎن‬ ‫ﺣﺰام‬

2
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Operator TUV           ‫اﻟﻤﺸﻐﻞ‬ ‫إﻋﺘﻤﺎد‬

3
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Tires                                  ‫اﻹﻃﺎرات‬

4
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Reverse Alarm   ‫ﻟﻠﺨﻠﻒ‬ ‫اﻟﺮﺟ ع‬ ‫إﻧﺬار‬

5
N/A No Yes

` Comments ‫ﻣﻼﺣﻈﺎت‬ Revolve Light            ‫اﻟﻤﺨﺎﻃﺮ‬ ‫إﺿﺎءة‬

6
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Sides Mirrors              ‫اﻟﺠﺎﻧ ﺔ‬ ‫اﻟﻤﺮا ﺎ‬

7
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Horn                               ‫اﻟﺘ ﺒ ﻪ‬ ‫آﻟﺔ‬

8
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Wipers                           ‫اﻟﻤﺴﺎﺣﺎت‬

9
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Fire Extinguisher        ‫اﻟﺤ ﻖ‬ ‫ﻃﻔﺎ ﺔ‬

10
N/A No Yes

 ‫واﻟﺨﻠﻔ ﺔ‬ ‫اﻷﻣﺎﻣ ﺔ‬ ‫اﻹﺿﺎءة‬

Comments ‫ﻣﻼﺣﻈﺎت‬
Front & Back Lights 
11
N/A No Yes

‫اﻟﻬ ﺪروﻟ ﻚ‬ ‫وﺻﻤﺎﻣﺎت‬ ‫ﺧﺮاﻃ ﻢ‬ ‫ﻓﺤﺺ‬

Comments ‫ﻣﻼﺣﻈﺎت‬
Hose pipe Inspection
12
N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Maintenance Log         ‫اﻟﺼ ﺎﻧﺔ‬ ‫ﺳﺠﻞ‬ Comments ‫ﻣﻼﺣﻈﺎت‬ Oil Leakage                   ‫اﻟ ﺖ‬ ‫ﺗﻬ ﺐ‬

14 13
N/A No Yes N/A No Yes

Comments : : ‫ﻣﻼﺣﻈﺎت‬

‫اﻟﺘﻮﻗﻴﻊ‬  ‫اﻟﻤﺸﻐﻞ‬ ‫إﺳﻢ‬
Signature Operator Name
‫ﺗﻮﻗ ﻌﻪ‬ ‫اﻟﻤﻌﺪات‬ ‫ﻗﺴﻢ‬ ‫ﻣﺴﺆول‬
‫اﻹﻋﺘﻤﺎد‬

Signature EQ Dep Response
‫ﺗﻮﻗ ﻌﻪ‬ ‫اﻟﺴﻼﻣﺔ‬ ‫ﻣ ف‬
Signature Safety Supervisor
‫ﺗﻮﻗ ﻌﻪ‬ ‫ﻣﺔ‬ ‫اﻟﺴﻼ‬ ‫ﻣﻬﻨﺪس‬
Signature Safety Engineer
 In Case The Equipment Excluded Please Reason For Exclusion  /                      /              : ‫اﻹﺳ ﻌﺎد‬ ‫ﺗﺎر ــﺦ‬ ‫اﻹﺳ ﻌﺎد‬ ‫ﺳ ﺐ‬ ‫ذﻛﺮ‬ ‫اﻟﺮﺟﺎء‬ ‫اﻟﻤﻌﺪة‬ ‫إﺳ ﻌﺎد‬  ‫ﺣﺎل‬ 

‫اﻟﺘﻨﻔ ﺬي‬ ‫اﻟﻤﺪﻳﺮ‬               ‫اﻟﺴﻼﻣﺔ‬ ‫ﻣﺪﻳﺮ‬             ‫اﻟﺴﻼﻣﺔ‬ ‫ﻣﻬﻨﺪس‬ 

‫اﻹﻋﺘﻤﺎد‬

Constructio Manager  Safety Manager Safety Engineer 

‫ﺗﻮﻗ ﻌﻪ‬ ‫ﺗﻮﻗ ﻌﻪ‬ ‫ﺗﻮﻗ ﻌﻪ‬
Signature Signature Signature
Archive Received Date   :                     /                 /                   /                /               : ‫ﺑﺘﺎر ــﺦ‬ ‫اﻷرﺷ ﻒ‬ ‫إﺳﺘﻼم‬
At The Time Of Inspection, This Equipment Was Safe For Work On The Project  ‫اﻟﻔﺤﺺ‬ ‫وﻗﺖ‬ ‫أﺛﻨﺎء‬ ‫وع‬ ‫ ﺎﻟﻤ‬ ‫ﻟﻠﻌﻤﻞ‬ ‫آﻣﻨﺔ‬ ‫اﻟﻤﻌﺪة‬ ‫ﻫﺬە‬