Title Page

  • Site conducted`

  • Conducted on

  • Prepared by

  • Location
  • Equipment #
  • What kind of equipment are you on

Exterior

  • Is the any Damage to the exterior of the machine (that has been not addressed previously)

  • Windshield, Glass & Screens

  • Windshield Wipers

  • Steps

  • Are grab bars present and in good condition

  • Engine Compartmentt Cleanliness

  • Check Engine oil

  • How much Engine oil did you add

  • Is the air filter clean

  • take necessary steps so that you can answer yes

  • Check Hydraulic fluid

  • How much Hydraulic fluid did you add

  • Are tracks clean

  • Clean tracks

  • Track pads

  • Track tension

  • Drive sprocket and wheels (Flat on top, Pointy on top)

  • Blade

  • Cutting edge condition (more than 1" of cutting edge below base metal)

  • Blade Hoses

  • Hydraulic rams and hoses

  • Machine Greased

  • Please take photos of the exterior of the equipment (so the pictures show all sides)

Interior

  • Inside Appearance (housekeeping)

  • Is the owners manual with the machine

  • Is there an current Annual Inspection for this machine

  • Is the fire extinguisher present and have a current inspection

  • Take a picture of the tag

  • Seat condition and Seat belt

  • Start Machine

  • Travel alarm - Back-up alarm audible when machine is running at full power

  • Headlights operational

  • Enter the hours

  • Are all gauges, switches, and electrical components functioning

  • Check the Engine oil

  • Is the air filter clean

  • Engine compartment cleanliness

  • Is the operators manual with the machine

  • Are the tires properly inflated and in acceptable condition

  • Please add a Photo with a brief description of the issue.

  • Is the annual inspection current on this equipment

  • Enter the Hours

  • VISUALLY INSPECT

  • FLUIDS - LEAKAGE

  • Did you address the issue and what steps were taken? Did you notify the appropriate personnel

  • CONTROL CABLES

  • WARNING LIGHTS

  • LABEL, TAGS OR PLACARDS

  • Did you Address issue and what steps were taken? Did you notify the appropriate personnel?

STRUCTURAL DAMAGE

  • WELDS

  • Did you Address issue and what steps were taken? Did you notify the appropriate personnel?

  • FASTENERS

  • Did you Address issue and what steps were taken? Did you notify the appropriate personnel?

FALL PROTECTION EQUIPMENT

  • FALL PROTECTION ATTACH PTS

  • What did you do to fix?

  • MAN/BASKET/PLATFORM

  • STEERING COMPONENTS

  • BATTERY COVER/ENGINE COVER

FLUID - LEVEL CHECKS

  • TIRES

  • Hoses

GROUND CONTROLS

  • DRIVE (forward & reverse)

  • STEER

  • ROTATE

  • EXTEND AND RETRACT (boom in & out)

  • BOOM (raise & lower)

  • BASKET/PLATFORM (level, rotate & extend)

  • AUXILIARY POWER

  • EMERGENCY STOP(S)

  • EMERGENCY DESCENT VALVES

  • OUTRIGGER

  • Enter the hours

PLATFORM / BASKET CONTROLS

  • DRIVE (forward & reverse)

  • STEER

  • ROTATE

  • EXTEND AND RETRACT (boom in & out)

  • BOOM (raise & lower)

  • BASKET/PLATFORM ( level, rotate & extend)

  • AUXILIARY POWER

  • EMERGENCY STOP(S)

Exterior

  • Are tracks clean and in good operational condition

  • Is the any Damage to the exterior of the machine (that has been not addressed previously)

  • Are there any loose bolts or loose or missing clamps?

  • Are there 4 Swing Stickers on the counterweight? (2 facing the rear of the machine and one on each side)

  • Are there any signs of fluids leaking under the machine

  • Please take photos of the exterior of the equipment (so the pictures show all sides)

Engine Compartment

  • Check Engine oil

  • How much Engine oil did you add

  • Check antifreeze/coolant

  • How much coolant did you add

  • Check swing oil

  • How much swing oil did you add

  • Inspect fire extinguisher

  • please take a picture of the fire extinguisher tag

  • Inspect and knock out air filter

  • Inspect fan belts for any visible damage/fraying/check tension

  • Are all lights, and wiring free of visible damage

Interior

  • General Vehicle Condition

  • Is the annual inspection current on this equipment

  • Please take a photo of the sticker

  • Is the hydraulic kit in the proper mode for current attachment

  • Is seat and safety restraint in good working condition

  • Is the glass in good condition and no damage since your last inspection on this equipment

  • Start the machine

  • Are instruments functioning and within normal ranges?

  • Enter the Machine Hours

  • Is the proper attachment number selected in the monitor?

  • Is the safety interlock device working? (safety lever)

  • Do the wipers and wiper fluid function as usual?

  • is the horn working?

  • is the travel alarm audible when the machine is at full RPM's

  • Do all levers function and respond as normal

  • Are there any warning alarms

  • Check Hydraulic oil (may have to revisit this question after you start and reposition the machine)

  • How much Hydraulic fluid did you add

  • Verify that all lights are working

Exterior

  • Is the any Damage to the exterior of the machine (that has been not addressed previously)

  • Windshield, Glass & Screens

  • Windshield wipers

  • Steps

  • Are grab bars present and in good condition

  • Engine Compartment Cleanliness

  • Check Engine Oil

  • Is air filter clean

  • Check Hydraulic Fluid

  • Are Tracks cleaned out

  • Track Pads

  • Track Tension

  • Drive Sprocket and Wheels

  • Are all lights, and wiring free of visible damage

  • Blade

  • Cutting edge condition (more than 1" of cutting edge below base metal)

  • Blade hoses

  • Hydraulic Rams & Hoses

  • Beacon

  • Machine Greased

Interior

  • Inside Appearance

  • Headlights

  • Rear Lights

  • Back Up Alarm (audible at full-throttle)

  • Operator Seat

  • Seat Belt

  • Are guages, switches, electricial working as normal

  • Fire Extinguisher.

  • Is the operators manual with the equipment

  • Is the annual inspection current on this equipment

  • Enter the hours

Exterior

  • Is the any Damage to the exterior of the machine (that has been not addressed previously)

  • TIRES OR TRACKS CUTS / WEAR / ETC

  • Assign an action to the appropriate personnel

  • Check Engine oil level

  • Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item

  • HOSES (Hydraulic, coolant)

  • Fuel System

  • Air filter

  • Check Antifreeze overflow tank level or check radiator when cold if not equipped with an overflow

  • Belts

  • Check Hydraulic oil

  • Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item

  • Check Transmission oil

  • Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item

  • Are the any visible leaks

  • EXHAUST SYSTEM

  • FRAME / SHEET METAL/BACK DOOR

  • GRAB HANDLES

  • MACHINE STEPS / BUCKET STEPS / NONSKID TAPE

  • LIGHTS / BEACON Present and free of damage

  • CAB / ROPS / FOP

  • AUXILIARY HYDRAULIC QUICK COUPLERS

  • ATTACHMENTS

Inside Cab

  • OPERATOR’S MANUAL

  • Is the annual inspection current on this equipment

  • FIRE EXTINGUISHER

  • Take a picture of the inspection tag including the gauge

  • SAFETY DECALS PRESENT

  • Start Machine

  • Is the glass free of cracks

  • OPERATOR'S SEAT BELT

  • EQUIPMENT HOURS

  • GAUGES / SWITCHES / ELECTRICAL

  • HORN

  • LIGHTS/BEACON

  • ANY DASH/DISPLAY WARNING LIGHTS OR CODE

  • STEERING / BRAKES / LEVERS functioning normally

  • BACKUP ALARM

  • Loader is in acceptable working condition

Exterior

  • 2 Wheel chocks present if required

  • Are Jack stands present and in working order

  • Safety chains present

  • Is the unit properly grounded? (Generator only)

  • All wiring and bulbs in acceptable condition (light plant)

  • Is bulb housing and stanchions in acceptable condition (light plant)

Generator Details

  • Is the Operator manual present and in legible condition?

  • Fuel level

  • Oil Level (adequate)

  • DEF fluid level

  • Is Coolant fluid level adequate (if no reservoir do not open radiator cap when engine is hot)

  • Is the battery in good condition with no visible leaks or corrosion?

  • Verify the voltage is set correctly for your application

  • Enter the hours

  • Is there any damage on the exterior of the vehicle? (New damage that has not been addressed previously)

  • Please explain and submit a photo.

  • Do tires appear to be in good condition?

  • Please notify the service truck personnel.

  • Are tires properly inflated?

  • Add air as required

  • Are there any glass chips or cracks? (New that has not been addressed previously)

  • Note any chips or cracks

  • Inspect the hose and connections for any visible leaks or deteriorations

  • Verify that there are at least 50 spill pads on board and 1-50lb bag of oil dry

  • Fix the issue so that you can answer yes

  • This is the picture for the Question below

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  • Are there stickers on the drivers and passengers sides of the tank that look like the picture above

  • This is the picture for the Question below

    IMG_1490[1].JPG
  • Is there a placard on the front bumper that looks like the picture above

  • Is the engine coolant at an acceptable level (do not remove radiator cap while engine is hot)

  • Is engine oil at an acceptable level

  • Check the air filter for cleanliness

  • clean as necessary (create an action item if you can remedy to cause the question to be answered positively)

Interior

  • Start the Truck

  • Is an oil change required on this vehicle?

  • Is there a current annual inspection from either DOT or Homrich

  • Take a picture of the Annual inspection

  • Is the a fire extinguisher present with current inspection tags

  • Is the horn audible?

  • Is there at least one seat belt for each seat?

  • Are there any warning lights on the dashboard? (New that has not been addressed previously)

  • Are all gauges within the normal range?

  • Are all turn signals and brake lights operational? You will need a buddy to complete this check.

  • Is there an audible back-up alarm on this vehicle?

  • Does this have an hour meter or odometer.

  • Enter the Mileage

  • Enter the hours

  • Are there any other issues you would like addresses.

  • Check the Engine oil

  • How much did you add (add until you can answer compliant)

  • Is the air filter clean

  • clean so that you can answer yes

  • Engine compartment cleanliness

  • clean so that you can make compliant or notify your supervisor

  • Is the operators manual with the air ccompressor

  • Are the tires properly inflated and in acceptable condition

  • check the fuel level

  • add fuel

  • add fuel

  • Check antifreeze level (visually in overflow tank if possible) (do not remove radiator cap if engine is hot)

  • Check compressor oil

  • How much was added

General Appearance

  • Is there new damage since the last time YOU did an inspection

  • Are all light free of visible damage

  • Data plate intact and legible

  • Fire extinguisher present with current inspection

  • Take a picture of the tag

  • Is the owners manual on the equipment

Chassis

  • Mast/Boom Condition

  • Carriage rollers and guides

  • Load back rest

  • Forks

  • Side shift

Engine

  • Type of fuel

  • Check the fuel level (you may need to do this after the machine is running)

  • Fuel system free of visible leaks

  • Are there any visible oil leaks

  • Visually check the radiator and fluid level

  • Enter the hours

  • Windshield, Glass & Screens

  • Windshield Wipers

  • Steps

  • Are grab bars present and in good condition

  • Engine Compartment Cleanliness

  • Check Engine oil

  • How much Engine oil did you add

  • Is the air filter clean

  • take necessary steps so that you can answer yes

  • Check Hydraulic fluid

  • How much Hydraulic fluid did you add

  • Are tracks clean

  • Clean tracks

  • Track pads

  • Track tension

  • Drive sprocket and wheels

  • Blade

  • Cutting edge condition (more than 1" of cutting edge below base metal)

  • Blade Hoses

  • Hydraulic rams and hoses

  • Machine Greased

Interior

  • Inside Appearance (housekeeping)

  • Is the owners manual with the machine

  • Is there an current Annual Inspection for this machine

  • Is the fire extinguisher present and have a current inspection

  • Take a picture of the tag

  • Seat condition and Seat belt

  • Start Machine

  • Travel alarm - Back-up alarm audible when machine is running at full power

  • Headlights operational

  • Enter the hours

  • Are all gauges, switches, and electrical components functioning

  • Walk around inspection - (Look around and under the vehicle for such items as loose bolts, trash build up, oil or coolant leaks, broken or worn parts)

  • Check fuel level - Fill when less than 1/4

  • Please add proper fuel

  • Check engine oil - Check oil before starting engine or at least 5 minutes after engine has stopped. Never mix two different types of oil

  • Add oil to proper level

  • Check brake fluid level - Never operate if brake fluid is below the “MIN” mark. If fluid is spilled on the power steering hose, quickly wash it off with water, brake fluid ruins rubber hoses

  • Add brake fluid to proper level

  • Check coolant level

  • Add coolant to proper level

  • Clean grill/radiator screen Remove all foreign materials

  • Check brake and speed control pedal - Ensure free travel and smooth operation

  • Check indicators, gauges and meter

  • Enter Hours

  • Check lights

  • Check seat belts

  • Check front and rear joint boots - Check boots for cuts, cracks or deterioration

  • Check tire pressure

  • Inflate tires to proper PSI

  • Check backup alarm

  • Check DANGER, WARNING CAUTION Labels

  • Sign only:

  • TIRES OR TRACKS CUTS / WEAR / ETC

  • Assign an action to the appropriate personnel

  • Check Engine oil level

  • Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item

  • HOSES (Hydraulic, coolant)

  • Fuel System

  • Air filter

  • Check Antifreeze overflow tank level or check radiator when cold if not equipped with an overflow

  • Belts

  • Check Hydraulic oil

  • Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item

  • Check Transmission oil

  • Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item

  • Are the any visible leaks

  • EXHAUST SYSTEM

  • FRAME / SHEET METAL/BACK DOOR

  • GRAB HANDLES

  • MACHINE STEPS / BUCKET STEPS / NONSKID TAPE

  • LIGHTS / BEACON Present and free of damage

  • CAB / ROPS / FOP

  • AUXILIARY HYDRAULIC QUICK COUPLERS

  • ATTACHMENTS

Inside Cab

  • OPERATOR’S MANUAL

  • Is the annual inspection current on this equipment

  • FIRE EXTINGUISHER

  • Take a picture of the inspection tag including the gauge

  • SAFETY DECALS PRESENT

  • Start Machine

  • Is the glass free of cracks

  • OPERATOR'S SEAT BELT

  • EQUIPMENT HOURS

  • GAUGES / SWITCHES / ELECTRICAL

  • HORN

  • LIGHTS/BEACON

  • ANY DASH/DISPLAY WARNING LIGHTS OR CODE

  • STEERING / BRAKES / LEVERS functioning normally

  • BACKUP ALARM

  • Loader is in acceptable working condition

  • Is the electrical cable in good condition? (No cuts or exposed wires)

  • Is the generator properly grounded?

  • Work with supervisor to obtain a proper ground before continuing use of Dust Boss

  • Is water source properly connected with no leaks?

  • Do what is necessary to minimize leaks

  • Is Pump working properly?

  • Is Oscillator working properly?

  • Is Fan working properly?

  • Are all spray nozzles clean and spraying

  • Work with supervisor on how to clean the spray nozzles

  • Please remember to drain the water from the Dust Boss at end of day

  • If you do not know how to complete, ask your supervisor.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.