Centurion American - Heavy Equipment Daily Pre-Use Inspection

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

• Name (person completing inspection)

• Client / Job Name

• Date and Time

  Date
• Location
  Address

Equipment Inspection

• Equipment Inspection

• What Heavy Equipment is being inspected?

  Select Backhoe Bucket Truck Crawler Carrier Dozer Dump Truck Hydro Excavator Front End Loader Manlift Morooka Carrier Motor Grader Mulcher Roller / Compactor Scissor Lift Scraper Skidsteer Telehandler / Fork Lift Trackhoe Tractor Trencher Water Truck Other

  • Backhoe
  • Bucket Truck
  • Crawler Carrier
  • Dozer
  • Dump Truck
  • Hydro Excavator
  • Front End Loader
  • Manlift
  • Morooka Carrier
  • Motor Grader
  • Mulcher
  • Roller / Compactor
  • Scissor Lift
  • Scraper
  • Skidsteer
  • Telehandler / Fork Lift
  • Trackhoe
  • Tractor
  • Trencher
  • Water Truck
  • Other

• Has Operator been trained and/or authorized to operate this Heavy Equipment?

  Yes

  No

  N/A

• Is Operator authorization / 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

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:

ATTACHMENTS

FLUID LEVELS

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:

• 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:

• Add pictures of any deficencies.

  Media

• COMMENTS:

SIGNATURES

• Operator's Signature:

  Sign

SIGNATURES

• Safety/Equipment Rep Signature:

  Sign