Title Page
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Site conducted
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Conducted on
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Location
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Creedence Employee Name
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Truck Unit Number
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Picture of truck
Documents
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Current Hazmat Registration Present?
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Vehicle Insurance Documentation Present?
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Vehicle Insurance Expiration Date
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Vehicle Registration / IRP Present?
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Vehicle Registration Expiration Date
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IFTA Documentation Current"
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Jicarilla Card and Vehicle Permit Present?
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Jicarilla Card Expiration Date
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Jicarilla Vehicle Permit Expiration Date
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Southern Ute Vehicle Permit Present?
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Southern Ute Vehicle Permit Expiration Date
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DOT Annual Inspection Documentation Present?
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Current DOT Special Permits?
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ELD Transfer Instruction Card Present?
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ELD Manual Present?
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Safety Data Sheets Present for all chemicals loaded on truck?
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Name of Chemical(s) with missing SDS
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HAZMAT Book Present? (Red)
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FMCSA Safety Regulations Book Present? (Green)
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Emergency Response Guidebook Present? (Orange)
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DOT Paper Logbook Present?
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Daily JSA Completed?
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BOL / Shipping Papers Present?
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Location of BOL / Shipping Papers during inspection?
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Chemical labels on tanks present and in good condition, matching the material in the containers?
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DOT Placarding Present? (If Applicable)
Safety and PPE
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Emergency roadside reflective triangles present?
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Grounding / Bonding practices being utilized?
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Extra fuses available?
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Wheel chocks available?
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Fire extinguisher secured in vehicle and accessible?
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Fire extinguisher annual and monthly inspection current?
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Truck interior clean and organized
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First aid kit available and current?
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Eye wash available?
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Spill kit present and stocked?
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Bucket for spill cleanup materials present?
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Shovel present?
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PPE Being Utilized
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Is the PPE being utilized appropriate for the chemicals being handled according to the SDS?
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Additional Comments
Signature Page
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Person Completing Inspection
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Signature
