Batzner Fleet Inpections (03/08/2017)

• Prepared by

• Conducted on

  Date

Vehicle Information

• Truck Number

• mileage

• Exterior Front photo

  Media

• Exterior drivers side photo

  Media

• Exterior rear photo

  Media

• Exterior Passenger side photo

  Media

• Interior Passenger side photo (Both Doors Opened)

  Media

• Interior Drivers Side Photo (Both Doors Opened)

  Media

Cab Interior

• Window Operation

  Yes

  No

  N/A

• Door Locks in working order

  Yes

  No

  N/A

• Seatbelts in working order

  Yes

  No

  N/A

• Interior Lights Work

  Yes

  No

  N/A

• Hazard lights work

  Yes

  No

  N/A

• Back-up Camera operational and adjusted properly

  Yes

  No

  N/A

• All company forms present

  Yes

  No

  N/A

• sales agreements

  Yes

  No

  N/A

• Pre Application Notices

  Yes

  No

  N/A

• Post Application Notices

  Yes

  No

  N/A

• Ban Welcome Packets

  Yes

  No

  N/A

• Seasonal Marketing Materials

  Yes

  No

  N/A

• Printer in good condition and stored properly

  Yes

  No

  N/A

• Heater and A/C working

  Yes

  No

  N/A

• Overall cleanliness of cab

• overall storage practices in Cab

Accident Packet/Emergency Products

• Insurance Card

  Yes

  No

  N/A

• Incident Reports

  Yes

  No

  N/A

• Accident Investigation Form

  Yes

  No

  N/A

• Instruction Sheet

  Yes

  No

  N/A

• UA Sign Off Form

  Yes

  No

  N/A

• Concentra Location Form

  Yes

  No

  N/A

• First Aid Kit Present and Stocked Properly

  Yes

  No

  N/A

• Spill Kit

  Yes

  No

  N/A

PPE

• Safety cone present and in good conditon

  Yes

  No

  N/A

• Bump Cap/Hard Hat present and in working condition.

  Yes

  No

  N/A

• Safety Glasses and Goggles present

  Yes

  No

  N/A

• Respirator present and stored properly

  Yes

  No

  N/A

• Extra Uniform

  Yes

  No

  N/A

• Coveralls Present

  Yes

  No

  N/A

• Spare Pair of work Boots. (Illinois only)

  Yes

  No

  N/A

• Stinging Insect PPE Present and in good condition

  Yes

  No

  N/A

Exterior

• Windows and windshield in good condition

  Yes

  No

  N/A

• Windshield wiper working

  Yes

  No

  N/A

• Turn signals working

  Yes

  No

  N/A

• Headlights functional low and high beam

  Yes

  No

  N/A

• Tail Lights & Brake Lights

  Yes

  No

  N/A

• Tires in good condition

  Yes

  No

  N/A

• Low Tread Life left

• Damaged tires

• Horn working

  Yes

  No

  N/A

• Mirrors properly adjusted/convex mirrors installed

  Yes

  No

  N/A

• Extension Ladder Properly Secured on vehicle

  Yes

  No

  N/A

• Overall Cleanliness of exterior

• Additional comments/observations or exterior damages noted attach photos below

Observation

• Add media

  Media

• Add observations/comments here.

Truck Bed

• products properly stored

  Yes

  No

  N/A

• water containers labeled

  Yes

  No

  N/A

• product containers labeled and sealed.

  Yes

  No

  N/A

• Proper amounts of products present.

  Yes

  No

  N/A

• Too much Product

• To little product

• Truck Cap Locks in working order

  Yes

  No

  N/A

• Overall cleanliness of truck bed

• Storage Practices in truck bed

• I hereby certify that all information is accurate and that an actual inspection was conducted.

• Auditor's Printed Name & Signature

  Sign

• Technicians signature

  Sign

STEP LADDER (Little Giant or telescoping)

• 1) Ladder joints are tight

  Yes

  No

  N/A

• 2) Rungs and side rails are free of slip hazards

  Yes

  No

  N/A

• 3) Rungs Undamaged

  Yes

  No

  N/A

• 4) Safety feet present and in good working order

  Yes

  No

  N/A

• 5) Side rails undamaged

  Yes

  No

  N/A

• 6) Warning Labels Present and legible.

  Yes

  No

  N/A

Small folding step ladders (If applicable)

• 1) Ladder Joints are tight?

  Yes

  No

  N/A

• 2) Rungs and side rails are free of slip hazards?

  Yes

  No

  N/A

• 3) Safety feet are present and in good working order?

  Yes

  No

  N/A

• 4) Rungs are undamaged?

  Yes

  No

  N/A

• 5) Side rails are undamaged?

  Yes

  No

  N/A

• 6) Warning Labels Present and legible.

  Yes

  No

  N/A

Extension ladders

• 1) Ladder joints are tight?

  Yes

  No

  N/A

• 2) Ladder extension stops are present and functional?

  Yes

  No

  N/A

• 3) Pulleys are in good working order?

  Yes

  No

  N/A

• 4) Pulley ropes are in good condition?

  Yes

  No

  N/A

• 5) Rungs and side rails are free of slip hazards?

  Yes

  No

  N/A

• 6) Rungs undamaged?

  Yes

  No

  N/A

• 7) Safety feet present and in good working order?

  Yes

  No

  N/A

• 8) Side rails undamaged?

  Yes

  No

  N/A

• 9) Warning Labels Present and legible.

  Yes

  No

  N/A