Checklist HP 2011
Checklist HP 2011
The pump operator completes this checklist at the start of the work.
*) Delete where not applicable. If one or more of these questions is answered with “no”, then
the work must not be started. This does not apply to the questions under “Special
circumstances”.
GENERAL
High pressure unit registration no.
Work permit number Issue date
Working area
DOCUMENTS
SIR (Senior) High Pressure Pump Operator certificate or driver is present and valid Yes / No*
SIR high pressure vehicle equipment is complete and valid inspection certificate is
Yes / No*
present
SIR inspection sticker is present on vehicle Yes / No*
SIR first aid card for high pressure injuries present at place of work Yes / No*
PERSONAL PROTECTION EQUIPMENT
Standard personal protection equipment present Yes / No*
Special personal protection equipment present
Yes / n.a.
If so, which
INSTALLATION OF UNIT
Are all utility facilities, such as fire hydrants, emergency showers, etc. free of
Yes / No*
blockades
Demarcation with continuous barrier material combined with warning signs at least 6
metres distance from the nozzle (in the horizontal plane and, if necessary, in the Yes / No*
vertical plane
Floor at working area stable and free from tripping and slipping hazards Yes / No*
EARTHING
Earthing cable is connected to an approved earthing point and is in proper order Yes / No / n.a.*
CONDITIONS
Emergency stop buttons tested and in proper order Yes / No*
Hoses are clean Yes / No / n.a.*
High pressure hoses may be used for hot water Yes / No / n.a.*
Operating elements, protection devices and alarms tested for proper function and in
Yes / No*
proper order
Hoses are visually in order and tested under working conditions Yes / No*
Hoses laid out without sharp bends or kinks and cannot be damaged by traffic Yes / No*
All measures taken in accordance with working permit, health and safety plan and, if
Yes / No*
applicable, JSA
If working with hose catcher, check in advance whether hose is caught in hose catcher Yes / No / n.a.*
SPECIAL CIRCUMSTANCES
Are chemicals added to the jet water Yes / No / n.a.*
Any deviations from SIR guidelines? If so, indicate on health & safety plan Yes / No*
Confined spaces involved
Yes / No*
If so, and if there is a risk of more than 10% LEL, take extra precautions
END OF WORK
Work permit returned Yes / No Location
Defects Yes / No If so, report to
Extra materials returned to magazine Yes / No*
Logbook completed Yes / No*
Completed by:
Name Date
Initials Time