Chain of Responsibility Checklist Example
Example document for Chain of Responsibility Checklist. Use this as a reference when creating your own.
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Document: Chain of Responsibility Checklist
Example Document
Last updated 7/29/2026
Chain of Responsibility Checklist
Business Name: Builder's Choice Supplies Pty Ltd ABN: 12 345 678 901 Date: 14 October 2023 Location: 42 Industrial Drive, Dandenong VIC
1. Task Details
| Field | Details |
|---|---|
| Job/Reference Number | ORD-9921 |
| Transport Company Name | Swift Haulage Co |
| Vehicle Registration | SWFT-123 |
| Driver Name | J. Smith |
| Consignor (Sender) | Builder's Choice Supplies |
| Consignee (Receiver) | Metro Constructions |
2. Scheduling and Routing
Did you check the following before setting the schedule?
- Realistic Timeframes: Pick up booked for 10:00 AM. Delivery window 2:00 PM - 4:00 PM allows 3 hours for transit and unloading.
- Fatigue Management: Driver confirmed start time was within legal hours.
- Route Suitability: Route passes under the Monash Freeway bridge. Height of load checked at 4.2m. Bridge clearance is 4.4m. Safe.
- Communication: Site contact provided.
Comments: Driver notified of tight entry at construction site.
3. Loading and Unloading
Did the person in charge of loading verify the following?
- Weight Limits: Total load 18.5 tonnes. GVM limit 22.5 tonnes.
- Load Restraint: 2 inch ratchet straps used on all four corners of pallets. Checked tension.
- Distribution: Weight placed centrally over axles.
- Compatibility: No mixed loads. Only timber pallets.
- Access: Bay 3 clear. Forklift ready.
Comments: None.
4. Packaging and Labelling
Have you checked the goods themselves?
- Integrity: Pallets wrapped in heavy duty plastic. No damage visible.
- Labelling: No hazardous materials.
- Stacking: Heaviest structural timber at bottom, lighter lining boards on top.
Comments: None.
5. Premises and Management
Is the site safe for heavy vehicles?
- Manoeuvring Space: Yard swept and clear of debris.
- Surface Condition: Concrete pad level.
- Overhead Hazards: No powerlines over loading bay.
- Supervision: Warehouse Manager M. Brown present.
Comments: None.
6. Verification and Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Loading Supervisor | M. Brown | Signed | 14/10/2023 |
| Driver | J. Smith | Signed | 14/10/2023 |
| Consignor/Receiver | M. Brown | Signed | 14/10/2023 |
7. Hazard Report
Were any hazards identified during this process?
- No
- Yes (Describe below)
Notes
This example shows a straightforward domestic delivery of construction materials. The verifier has physically checked the load restraint and weight limits, which are critical for timber products that can shift if not strapped correctly. The routing check specifically mentions bridge clearance, which is a common failure point for high loads.
About this Example
Part of the Chain of Responsibility Checklist document collection
Document Type
Chain of Responsibility Checklist
A practical tool to help businesses in the heavy vehicle supply chain identify and manage safety risks under Australian law.