A-Frame or Flatbed 6/13

• Document No.

• Equipment # and Group Abbreviation

• Customer

  Select Chevron Aera

  • Chevron
  • Aera

• Location

  Select Kern River (CVX) Belridge (Aera) Cymric (CVX) North Midway (Aera) South Midway (Aera) Midway (CVX) Coalinga

  • Kern River (CVX)
  • Belridge (Aera)
  • Cymric (CVX)
  • North Midway (Aera)
  • South Midway (Aera)
  • Midway (CVX)
  • Coalinga

• Work Group

  Select New Construction Maintenance Lead Line F/I DTR Infrastructure Developement I and E Production

  • New Construction
  • Maintenance
  • Lead Line
  • F/I
  • DTR
  • Infrastructure
  • Developement
  • I and E
  • Production

• EMC/IRT

  Select Belridge Coalinga/Kettleman Cymric Kern River Midway Ventura

  • Belridge
  • Coalinga/Kettleman
  • Cymric
  • Kern River
  • Midway
  • Ventura

• Foreman or Superintendent

• Conducted on

  Date

• Auditor

  Select Brent Walker Orrin Bowen Jim Jensen Jerry Fannon Bill Craddock

  • Brent Walker
  • Orrin Bowen
  • Jim Jensen
  • Jerry Fannon
  • Bill Craddock
• Location
  Address

• Appropriate Driver' License

  Yes

  No

  N/A

• Medical Card w/ DMV Stamp

  Yes

  No

  N/A

• Current Registration and Insurance Card

  Yes

  No

• Current KSI A-Frame Card

  Yes

  No

  N/A

• Complete Preshift w/ supervisors signature

  Yes

  No

• Proper Journey Management

  Yes

  No

• Brakes Properly Adjusted

  Yes

  No

  N/A

• Are all your Tool Boxes in Proper Working Order

  Yes

  No

• Spring Or Steering Damage

  No

  Yes

• Frame or Body Damage

  No

  Yes

• Tires and Wheels in Good Shape

  Yes

  No

• Clutch Working Properly

  Yes

  No

  N/A

• Is Bed in Good Shape

  Yes

  No

• Has Your Line Been Inspected ( Kinks, Broken Wire, Bird Caging)

  Yes

  No

  N/A

• Hook and Block in Good Shape

  Yes

  No

  N/A

• Pulley's Been Greased

  Yes

  No

  N/A

• Any Leaks ( Oil, Steering, Diff., Coolant, Fuel, Hydraulic)

  No

  Yes

• All Controls Working Properly

  Yes

  No

  N/A

• A-Frame Structure and Bolts Checked for Damage

  Yes

  No

  N/A

• Is there a Load Chart

  Yes

  No

  N/A

• Is This Equipment in Good Working Order

  Yes

  No

• Does This Equipment Look Clean and Cared For

  Yes

  No

• Have You Turned in a Repair Request

  No

  Yes

  N/A

• Photo of preshift if there are repairs or if not filled out correctly

  Media

Employee Information

• EE #

• Add signature

  Sign