Title Page
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Conducted on
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Prepared by
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Location
Information
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Make:
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Model:
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Serial #:
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Equip#:
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Select either Yes or No
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Is Parking Break in working condition?
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Take of picture of component.
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Is Flashing Beacon in working condition?
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Take of picture of component.
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Is the Fire Extinguisher in its assigned place and in working order?
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Take of picture of component.
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Is the Operating Manual in its assigned place?
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Take of picture of component.
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Is there any damage on the extended pistons?
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Take of picture of component.
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Is there any other damage not noted above?
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Add pictures of any other damage.
Acknowledgement
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Customer Acknowledgement: The safety and performance of this equipment has been verified. I am responsible for routine service and cleaning as user of this equipment. I understand the correct operation and function of the controls and confirm that I have received adequate instruction, and acknowledge the safety sheet to enable myself and/or my crew to use the equipment in a safe and proper manner without risk to injury.
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Received By:
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Released By:
