Saudi 

Binladin Group
TRANSPORT AND HEAVY EQUIPMENT
Document No: SBG‐HSE – 015‐019                                            Revision: 7

Date Modified: 24‐05‐2018

EQ Type ‫اﻟﻤﻌﺪة‬ ‫ﻧ ع‬ DUMPER TRUCK Date of inspection  ‫اﻟﻔﺤﺺ‬ ‫ﺗﺎر ــﺦ‬

Car NO   ‫اﻟﻠﻮﺣﺔ‬ ‫رﻗﻢ‬ Inspection No ‫اﻟﻔﺤﺺ‬ ‫رﻗﻢ‬
Manufacture Company  ‫اﻟﻤﺼﻨﻌﺔ‬ ‫اﻟ ﻛﺔ‬  Driver Name  ‫اﻟﺴﺎاﺋﻖ‬ ‫اﺳﻢ‬
EQ TUV NO  ‫اﻟﻤﻌﺪة‬ ‫إﻋﺘﻤﺎد‬ ‫رﻗﻢ‬ License No  ‫اﻟﺮﺧﺼﺔ‬ ‫رﻗﻢ‬
KSA License NO ‫اﻟﺴﻌﻮد ﺔ‬ ‫اﻟﺮﺧﺼﺔ‬ ‫رﻗﻢ‬ Exp Date license  ‫اﻟﺮﺧﺼﺔ‬ ‫اﻧﺘﻬﺎء‬ ‫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 Driver License            ‫اﻟﺴﺎﺋﻖ‬ ‫رﺧﺼﺔ‬

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

‫ﻟﻠﻤﺸﻐﻞ‬  ‫اﻟﻴﻮ‬ ‫اﻟﻔﺤﺺ‬  ‫واﻟﺨﻠﻔ ﺔ‬ ‫اﻷﻣﺎﻣ ﺔ‬ ‫اﻹﺿﺎءة‬

Comments ‫ﻣﻼﺣﻈﺎت‬ Comments ‫ﻣﻼﺣﻈﺎت‬
Daily inspection (operator)  Front & Back Lights 
15 11
N/A No Yes N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Doors                          ‫اﻷﺑﻮاب‬ ‫ﺳﻼﻣﺔ‬ Comments ‫ﻣﻼﺣﻈﺎت‬ Diesel  Leak                ‫دﻳﺰل‬ ‫ﺗﻬ ﺐ‬

16 12
N/A No Yes N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ ‫اﻟﻘﻼب‬ ‫ﺟﺴﻢ‬ ‫ﺳﻼﻣﺔ‬ Comments ‫ﻣﻼﺣﻈﺎت‬ Brake                            ‫اﻟﻔﺮاﻣ ــﻞ‬

17 13
N/A No Yes N/A No Yes

Comments ‫ﻣﻼﺣﻈﺎت‬ Maintenance Sheet          ‫اﻟﺼ ﺎﻧﺔ‬ ‫ﺟﺪول‬ Comments ‫ﻣﻼﺣﻈﺎت‬ First Aid Kit   ‫اﻷوﻟ ﺔ‬ ‫اﻹﺳﻌﺎﻓﺎت‬ ‫ﺷﻨﻄﺔ‬

18 14
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