BOS Heavy Equipment Daily Pre-Use Inspection

• This template should be used daily as a Pre-Use Inspection for Heavy Equipment.

• FIRST NAME/LAST NAME

• Client Name and Rig Name

• District

  Select Appalachia Grande Prairie Leduc Midland North Dakota Rio Vista Houston Office

  • Appalachia
  • Grande Prairie
  • Leduc
  • Midland
  • North Dakota
  • Rio Vista
  • Houston Office

• Date and Time

  Date
• Location
  Address

• What Heavy Equipment is being inspected?

  Fork Lift

  Front Loader

  Track Hoe

  Other

• Have you been trained and certified by BOS Solutions to operate this Heavy Equipment?

  Yes

  No

  N/A

• Is your certification current?

  Yes

  No

  N/A

• Please Write Type of Heavy Equipment

• MAKE & MODEL:

• Hour Meter / Odometer:

• General Equipment Condition: ( if unacceptable explain in comments section )

  Select Operable Needs repair N/A

  • Operable
  • Needs repair
  • N/A

WALK AROUND VISUAL INSPECTION

• Cleanliness

  Clean

  Needs cleaning

• Fluid Leaks

  No leaks

  Leaking

• Broken Glass

  No broken glass

  Broken glass

• Body or Structural Damage

  Operable

  Needs repair

  N/A

• Tires / Tracks - Inflated / Adjusted Properly

  Operable

  Needs repair

  N/A

• Fire Extinguisher Equipped and Charged

  Operable

  Needs repair

  N/A

• Mirrors

  Operable

  Needs repair

  N/A

• Mud Flaps

  Operable

  Needs repair

  N/A

• Wipers, Lights, Reflectors

  Operable

  Needs repair

  N/A

• Ladders / Steps and Grab Rails

  Operable

  Needs repair

  N/A

• Decals Installed and Legible

  Yes

  No

  N/A

• Loose Parts or Missing Covers - if applicable include in comments<br>

  OK

  Service/Repair

  Unacceptable

  N/A

• Belts and Hoses Servicable

  Operable

  Needs repair

  N/A

• Exhaust System

  Operable

  Needs repair

  N/A

• Hydraulic Lines and Cylinders

  Operable

  Needs repair

  N/A

• Batteries and Cables

  Operable

  Needs repair

  N/A

• Broken Welds

  Yes

  No

  N/A

• Regulatory Inspection Current

  Yes

  No

  N/A

• Lug Nuts / Rims

  Operable

  Needs repair

  N/A

• COMMENTS:

FLUID LEVELS

• Engine Oil

  Full

  Needs Fluid

  N/A

• Transmission Fluid

  Full

  Needs Fluid

  N/A

• Hydraulic Fluid

  Full

  Needs Fluid

  N/A

• Coolant

  Full

  Needs Fluid

  N/A

• Fuel

  Full

  Needs Fluid

  N/A

• Lubricants

  OK

  Service/Repair

  Unacceptable

  N/A

• COMMENTS:

ATTACHMENTS

• Add pictures of any deficencies.

  Media

• COMMENTS:

CAB OPERATIONAL CHECK

• Cleanliness

  Operable

  Needs repair

  N/A

• Seat and Seatbelts

  Operable

  Needs repair

  N/A

• Gauges and Instruments

  Operable

  Needs repair

  N/A

• Controls and Levers

  Operable

  Needs repair

  N/A

• Parking Brake

  Operable

  Needs repair

  N/A

• Service Brake

  Operable

  Needs repair

  N/A

• Emergency Shutdown

  Operable

  Needs repair

  N/A

• Steering System

  Operable

  Needs repair

  N/A

• Heater and AC System

  Operable

  Needs repair

  N/A

• Horn, Warning Alarms / Devices

  Operable

  Needs repair

  N/A

• Clutches

  Operable

  Needs repair

  N/A

• Drives

  Operable

  Needs repair

  N/A

• Transmission

  Operable

  Needs repair

  N/A

• Engine

  Operable

  Needs repair

  N/A

• Hydraulic Mechanisms

  Operable

  Needs repair

  N/A

• Electrical Wiring

  Operable

  Needs repair

  N/A

• Daily Log / Inspection Book

  Yes

  No

  N/A

• Is equipment in safe operating condition?

  Yes

  No

  N/A

• Is the Operator's Manual in the equipment cab?

  Yes

  No

  N/A

• COMMENTS:

SIGNATURES

• Operator's Signature:

  Sign