Mobile Plant Experience Checklist
Transcript of Mobile Plant Experience Checklist
Process Owner or Function:
HR Management
Document ID:
RR-HR-FM-022
Rev. No:
03
Effective Date:
01/07/2017
Name of Form- Mobile Plant Experience Checklist & Declaration
Mobile Plant Experience Checklist
1. Please check or tick the appropriate box indicating your experience on each machine.
2. Where machines are not listed please use blank spaces to write them in.
3. Employee Name: Date Of Completion:
Excavators 3-6
Mths
6-12
Mths
1-2
Yrs
2-3
Yrs
3-5
Yrs
5+
Yrs
Graders 3-6
Mths
6-12
Mths
1-2
Yrs
2-3
Yrs
3-5
Yrs
5+
Yrs 5-30 Tonne 120/140
30-70 Tonne 12/14 G/H
70-100 Tonne 16 G/H
PC1250 120/140M
Hitachi 1200 12/14M
Hitachi 1900 16M
Hitachi 2500 24M
Hitachi 3600
Hitachi 4500
Hitachi 5500
Hitachi 8000
Komatsu PC1250
Komatsu PC2000 Loaders 3-6 6-12 1-2 2-3 3-5 5+
Komatsu PC3000 CAT Komatsu PC4000 966/989 H Komatsu PC5500 988/990 H
Komatsu PC7000 992/993
Komatsu PC8000 994F
Dump Truck 3-6 6-12 1-2 2-3 3-5 5+ Komatsu
25/30t Artic WA250
35/40t Artic WA500
CAT 769/775 WA600
CAT 777 C/D/F WA900
CAT 785 C/D/F WA1200
CAT 789 P&H L-1150
Komatsu HD 785 P&H L-1350
Komat730E P&H L-1850
Komat830E P&H L-2350
Komat930E
Komat980E
Dozers 3-6 6-12 1-2 2-3 3-5 5+ Other 3-6 6-12 1-2 2-3 3-5 5+
D6/D7 Backhoe
D8 R/T Bobcat
D9 N/T CAT/VOLVO IT
D10 N/T Artic W/Cart
D11 N/T CAT 769/773
824 C Toyota Lv’s
D375A Lighting Plant
D475A Generators
Forklifts
Drills 3-6 6-12 1-2 2-3 3-5 5+ MD6200
MD6250
MD6310
MD6540C
MD6640
P&H 250XPC
P&H 285XPC
P&H 320XPC
P&H 77XR
Please list any other relevant earthmoving plant Experience:
I declare that I have worked and have experience on the above ticked mobile plant equipment;
Signed Employee
Date:
Employer Witness
Date:
Doc No-RR-HR-FM-022 Uncontrolled when printed page 1
Form
(serious legal consequences apply to false or misleading information and can lead to employment terminated)