Application Equipment Quarterly Evaluation - Version 1-5

• Unit Number

• Unit Description

  Select

• Location

  Select

• Current Hours

• Conducted on

  Date

• Prepared by

• Operator

All Units Outside Overall Condition

• Radiator Area Cleanliness

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Hood Bolts Intact

  Yes

  No

  N/A

• Fenders Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Front Entry Ladder Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Catwalks and Handrails Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Cab and Door Glass Cracked or Broken<br>

  Intact

  Broken

  N/A

• Mirrors Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Headlights, Brake lights, Tail Lights, Flashers in working order<br>

  Yes

  No

  N/A

• Overall Paint Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Engine Compartment Cleanliness

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Beacon If Equipped in Working Order<br>

  Yes

  No

  N/A

• Windshield Wiper Working

  Yes

  No

  N/A

• GPS and Slingshot Antenna in Working Order

  Yes

  No

  N/A

• Muffler and Exhaust Pipe Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Wheel Motors Leaking (Be Specific)

  Not Leaking

  Leaking

  N/A

• Hydraulic Motors Leaking (Be Specific)

  Not Leaking

  Leaking

  N/A

• Main Hydraulic Box Cleanliness (Case Dry Floaters)

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Hydraulic Hoses

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Hub Oil Leaks

  Not Leaking

  Leaking

  N/A

• Steering Cylinder Leaks

  Not Leaking

  Leaking

  N/A

• Suspension Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Axle Liners (Case Row Crop Units) In Place

  Yes

  No

  N/A

• Wheel Legs ( All Row Crop Units) Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Auto Greaser Level

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Auto Greaser Hoses and Fittings missing or broken

  Intact

  Missing/Broken

  N/A

• Tires Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

Cab Area Inside (All Units)

• Current DVIR Book <br>

  Yes

  No

  N/A

• Properly secured and functioning fire extinguisher in place?

  Yes

  No

  N/A

• Seat Area Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Floor Area Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Overall Inside Cab Cleanliness

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Rear View Camera if Equipped in Working Order

  Yes

  No

  N/A

Product Delivery Area Dry Units

• Product Venturi's Cleanliness

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Product Delivery Belts Cleanliness

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Product Distribution Tubes Cleanliness

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Fold Cylinder Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom to Distributor Alignment

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Breakaway's Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Breakaway Springs Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Cradle Locks Working

  Yes

  No

  N/A

• Boom Suspension Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Welds Cracking

  Intact

  Missing/Broken

  N/A

• Boom Product Deflectors Worn

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Structure Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Product Delivery Hoses

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Rear Boom Delivery Tubes

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Product Delivery Fans Condition (Note Current Hours since fan has been Changed)

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Auger Flighting Condition (Case Dry Air Floater)

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Auger Inspection doors working (Case Dry Air Floater)

  Yes

  No

  N/A

• Auger Bearings Condition (Case Dry Air Floater)

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Overall Cleanliness of Product Distribution Area

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Co-App Gandy Wheels Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Supplemental Gandy Wheels Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Micro Bins (Row Crop Spinner and Dry Air Units) Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Electric Roll Tarp Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Main Product Box Mounting System Intact

  Intact

  Broken

  N/A

• Fuel Tank Area Cleanliness (Case Dry Air Floater)

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Spinner Blades

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Product Delivery Chains (Ag Chem Dry Air)

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

Product Delivery System Liquid Row Crop Sprayers/Floaters

• Product Pump System Leaks

  Not Leaking

  Leaking

  N/A

• Product Tank Mounting Bolts Intact

  Intact

  Missing/Broken

  N/A

• Product Delivery Hoses Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Structure Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Welds Cracking or Bent

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Break Away Structure Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Function Cylinders Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Boom Break Away Cables and Springs Missing

  Intact

  Missing/Broken

  N/A

• Stainless Steel Boom Pipes Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Auto Boom Height Sensors and Wiring (If Equipped) Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Aim Command Coils and Wiring (If Equipped) Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Nozzle Bodies (Leaks, Cracking, Missing)

  Intact

  Missing/Broken

  N/A

• Product Strainers (Leaking, etc.)

  Not Leaking

  Leaking

  N/A

• Chemical Injection System (If Equipped) Condition

  Select 1 2 3 4 5 N/A

  • 1
  • 2
  • 3
  • 4
  • 5
  • N/A

• Signature of Inspector

  Sign

• Signature of Operator

  Sign

• Signature of Manager

  Sign