DELIVERY VEHICLE PRE-ENTRY SAFETY CHECKLIST DELIVERY VEHICLE PRE-ENTRY SAFETY CHECKLIST

Tabangao Refinery Tabangao Refinery

Plate No. Date: Plate No. Date:

Company: Company:

A. Personnel A. Personnel
1. Safety Video has been viewed 1. Safety Video has been viewed
2. Appropriate PPE 2. Appropriate PPE
safety shoes / long-sleeved cotton shirt / safety shoes / long-sleeved cotton shirt /
helmet / gloves / safety glass helmet / gloves / safety glass
3. No prohibited items 3. No prohibited items
lighter / match / weapon / electronic eqpt. lighter / match / weapon / electronic eqpt.
B. LICENSE AND REGISTRATION B. LICENSE AND REGISTRATION
1. Valid driver's license appropriate 1. Valid driver's license appropriate
to the category of vehicle to the category of vehicle
2. Valid documentation of vehicle - 2. Valid documentation of vehicle -
Insurance & vehicle registration Insurance & vehicle registration
C. TIRES C. TIRES
1. Thread depth not less than 2mm 1. Thread depth not less than 2mm
2. No recap tires in front 2. No recap tires in front
3. No tire wall damage 3. No tire wall damage
4. Spare tire provide 4. Spare tire provide
5. Stud bolt complete 5. Stud bolt complete
D. EXHAUST SYSTEM D. EXHAUST SYSTEM
1. No badly fitted joints 1. No badly fitted joints
2. No leaks 2. No leaks
E. ENGINE FUEL SYSTEM E. ENGINE FUEL SYSTEM
1. Starts easily / No stalling 1. Starts easily / No stalling
2. No fuel line and tank leak 2. No fuel line and tank leak
F. OTHERS F. OTHERS
1. Seat Belts 1. Seat Belts
2. Brake hold 2. Brake hold
3. Fire extinguisher 3. Fire extinguisher
4. Tire choke 4. Tire choke

INSTRUCTION TO GUARD: INSTRUCTION TO GUARD:

1. Check box if item is OK 1. Check box if item is OK
2. Report deficient item in the checklist to the 2. Report deficient item in the checklist to the
delivery focal point delivery focal point
3. Duplicate copy shall be issued to driver 3. Duplicate copy shall be issued to driver

Inspected by: Inspected by:

Remarks: Remarks:

Driver: Driver:
Helper: Helper:
Acknowledged by: Acknowledged by:
(Driver's Signature) (Driver's Signature)