Title Page
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Site conducted`
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Conducted on
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Prepared by
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Location
Equipment #
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What kind of equipment are you on
- Skidsteer/Telehandler
- Excavator
- Dozer
- Aerial lift
- Wheel Loader
- Towable Generator/Light plant
- Towable Air Compressor
- Track Loader
- Fuel Truck/Water Truck/Off Road Truck
- fork truck/hilo
- UTV
- Roller
- Dust Boss
Exterior
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Is the any Damage to the exterior of the machine (that has been not addressed previously)
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Windshield, Glass & Screens
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Windshield Wipers
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Steps
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Are grab bars present and in good condition
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Engine Compartmentt Cleanliness
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Check Engine oil
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How much Engine oil did you add
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Is the air filter clean
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take necessary steps so that you can answer yes
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Check Hydraulic fluid
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How much Hydraulic fluid did you add
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Are tracks clean
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Clean tracks
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Track pads
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Track tension
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Drive sprocket and wheels (Flat on top, Pointy on top)
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Blade
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Cutting edge condition (more than 1" of cutting edge below base metal)
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Blade Hoses
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Hydraulic rams and hoses
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Machine Greased
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Please take photos of the exterior of the equipment (so the pictures show all sides)
Interior
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Inside Appearance (housekeeping)
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Is the owners manual with the machine
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Is there an current Annual Inspection for this machine
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Is the fire extinguisher present and have a current inspection
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Take a picture of the tag
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Seat condition and Seat belt
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Start Machine
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Travel alarm - Back-up alarm audible when machine is running at full power
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Headlights operational
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Enter the hours
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Are all gauges, switches, and electrical components functioning
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Check the Engine oil
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Is the air filter clean
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Engine compartment cleanliness
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Is the operators manual with the machine
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Are the tires properly inflated and in acceptable condition
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Please add a Photo with a brief description of the issue.
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Is the annual inspection current on this equipment
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Enter the Hours
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VISUALLY INSPECT
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FLUIDS - LEAKAGE
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Did you address the issue and what steps were taken? Did you notify the appropriate personnel
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CONTROL CABLES
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WARNING LIGHTS
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LABEL, TAGS OR PLACARDS
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Did you Address issue and what steps were taken? Did you notify the appropriate personnel?
STRUCTURAL DAMAGE
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WELDS
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Did you Address issue and what steps were taken? Did you notify the appropriate personnel?
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FASTENERS
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Did you Address issue and what steps were taken? Did you notify the appropriate personnel?
FALL PROTECTION EQUIPMENT
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FALL PROTECTION ATTACH PTS
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What did you do to fix?
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MAN/BASKET/PLATFORM
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STEERING COMPONENTS
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BATTERY COVER/ENGINE COVER
FLUID - LEVEL CHECKS
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TIRES
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Hoses
GROUND CONTROLS
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DRIVE (forward & reverse)
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STEER
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ROTATE
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EXTEND AND RETRACT (boom in & out)
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BOOM (raise & lower)
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BASKET/PLATFORM (level, rotate & extend)
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AUXILIARY POWER
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EMERGENCY STOP(S)
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EMERGENCY DESCENT VALVES
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OUTRIGGER
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Enter the hours
PLATFORM / BASKET CONTROLS
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DRIVE (forward & reverse)
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STEER
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ROTATE
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EXTEND AND RETRACT (boom in & out)
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BOOM (raise & lower)
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BASKET/PLATFORM ( level, rotate & extend)
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AUXILIARY POWER
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EMERGENCY STOP(S)
Exterior
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Are tracks clean and in good operational condition
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Is the any Damage to the exterior of the machine (that has been not addressed previously)
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Are there any loose bolts or loose or missing clamps?
- Yes
- No
- N/A
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Are there 4 Swing Stickers on the counterweight? (2 facing the rear of the machine and one on each side)
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Are there any signs of fluids leaking under the machine
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Please take photos of the exterior of the equipment (so the pictures show all sides)
Engine Compartment
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Check Engine oil
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How much Engine oil did you add
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Check antifreeze/coolant
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How much coolant did you add
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Check swing oil
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How much swing oil did you add
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Inspect fire extinguisher
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please take a picture of the fire extinguisher tag
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Inspect and knock out air filter
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Inspect fan belts for any visible damage/fraying/check tension
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Are all lights, and wiring free of visible damage
Interior
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General Vehicle Condition
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Is the annual inspection current on this equipment
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Please take a photo of the sticker
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Is the hydraulic kit in the proper mode for current attachment
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Is seat and safety restraint in good working condition
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Is the glass in good condition and no damage since your last inspection on this equipment
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Start the machine
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Are instruments functioning and within normal ranges?
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Enter the Machine Hours
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Is the proper attachment number selected in the monitor?
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Is the safety interlock device working? (safety lever)
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Do the wipers and wiper fluid function as usual?
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is the horn working?
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is the travel alarm audible when the machine is at full RPM's
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Do all levers function and respond as normal
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Are there any warning alarms
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Check Hydraulic oil (may have to revisit this question after you start and reposition the machine)
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How much Hydraulic fluid did you add
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Verify that all lights are working
Exterior
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Is the any Damage to the exterior of the machine (that has been not addressed previously)
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Windshield, Glass & Screens
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Windshield wipers
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Steps
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Are grab bars present and in good condition
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Engine Compartment Cleanliness
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Check Engine Oil
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Is air filter clean
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Check Hydraulic Fluid
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Are Tracks cleaned out
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Track Pads
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Track Tension
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Drive Sprocket and Wheels
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Are all lights, and wiring free of visible damage
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Blade
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Cutting edge condition (more than 1" of cutting edge below base metal)
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Blade hoses
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Hydraulic Rams & Hoses
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Beacon
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Machine Greased
Interior
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Inside Appearance
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Headlights
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Rear Lights
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Back Up Alarm (audible at full-throttle)
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Operator Seat
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Seat Belt
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Are guages, switches, electricial working as normal
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Fire Extinguisher.
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Is the operators manual with the equipment
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Is the annual inspection current on this equipment
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Enter the hours
Exterior
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Is the any Damage to the exterior of the machine (that has been not addressed previously)
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TIRES OR TRACKS CUTS / WEAR / ETC
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Assign an action to the appropriate personnel
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Check Engine oil level
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Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item
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HOSES (Hydraulic, coolant)
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Fuel System
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Air filter
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Check Antifreeze overflow tank level or check radiator when cold if not equipped with an overflow
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Belts
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Check Hydraulic oil
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Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item
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Check Transmission oil
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Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item
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Are the any visible leaks
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EXHAUST SYSTEM
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FRAME / SHEET METAL/BACK DOOR
- Good
- Fair
- Poor
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GRAB HANDLES
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MACHINE STEPS / BUCKET STEPS / NONSKID TAPE
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LIGHTS / BEACON Present and free of damage
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CAB / ROPS / FOP
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AUXILIARY HYDRAULIC QUICK COUPLERS
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ATTACHMENTS
Inside Cab
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OPERATOR’S MANUAL
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Is the annual inspection current on this equipment
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FIRE EXTINGUISHER
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Take a picture of the inspection tag including the gauge
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SAFETY DECALS PRESENT
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Start Machine
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Is the glass free of cracks
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OPERATOR'S SEAT BELT
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EQUIPMENT HOURS
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GAUGES / SWITCHES / ELECTRICAL
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HORN
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LIGHTS/BEACON
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ANY DASH/DISPLAY WARNING LIGHTS OR CODE
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STEERING / BRAKES / LEVERS functioning normally
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BACKUP ALARM
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Loader is in acceptable working condition
Exterior
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2 Wheel chocks present if required
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Are Jack stands present and in working order
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Safety chains present
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Is the unit properly grounded? (Generator only)
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All wiring and bulbs in acceptable condition (light plant)
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Is bulb housing and stanchions in acceptable condition (light plant)
Generator Details
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Is the Operator manual present and in legible condition?
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Fuel level
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Oil Level (adequate)
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DEF fluid level
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Is Coolant fluid level adequate (if no reservoir do not open radiator cap when engine is hot)
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Is the battery in good condition with no visible leaks or corrosion?
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Verify the voltage is set correctly for your application
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Enter the hours
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Is there any damage on the exterior of the vehicle? (New damage that has not been addressed previously)
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Please explain and submit a photo.
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Do tires appear to be in good condition?
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Please notify the service truck personnel.
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Are tires properly inflated?
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Add air as required
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Are there any glass chips or cracks? (New that has not been addressed previously)
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Note any chips or cracks
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Inspect the hose and connections for any visible leaks or deteriorations
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Verify that there are at least 50 spill pads on board and 1-50lb bag of oil dry
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Fix the issue so that you can answer yes
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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
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This is the picture for the Question below
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Is there a placard on the front bumper that looks like the picture above
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Is the engine coolant at an acceptable level (do not remove radiator cap while engine is hot)
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Is engine oil at an acceptable level
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Check the air filter for cleanliness
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clean as necessary (create an action item if you can remedy to cause the question to be answered positively)
Interior
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Start the Truck
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Is an oil change required on this vehicle?
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Is there a current annual inspection from either DOT or Homrich
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Take a picture of the Annual inspection
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Is the a fire extinguisher present with current inspection tags
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Is the horn audible?
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Is there at least one seat belt for each seat?
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Are there any warning lights on the dashboard? (New that has not been addressed previously)
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Are all gauges within the normal range?
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Are all turn signals and brake lights operational? You will need a buddy to complete this check.
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Is there an audible back-up alarm on this vehicle?
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Does this have an hour meter or odometer.
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Enter the Mileage
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Enter the hours
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Are there any other issues you would like addresses.
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Check the Engine oil
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How much did you add (add until you can answer compliant)
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Is the air filter clean
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clean so that you can answer yes
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Engine compartment cleanliness
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clean so that you can make compliant or notify your supervisor
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Is the operators manual with the air ccompressor
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Are the tires properly inflated and in acceptable condition
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check the fuel level
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add fuel
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add fuel
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Check antifreeze level (visually in overflow tank if possible) (do not remove radiator cap if engine is hot)
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Check compressor oil
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How much was added
General Appearance
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Is there new damage since the last time YOU did an inspection
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Are all light free of visible damage
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Data plate intact and legible
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Fire extinguisher present with current inspection
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Take a picture of the tag
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Is the owners manual on the equipment
Chassis
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Mast/Boom Condition
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Carriage rollers and guides
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Load back rest
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Forks
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Side shift
Engine
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Type of fuel
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Check the fuel level (you may need to do this after the machine is running)
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Fuel system free of visible leaks
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Are there any visible oil leaks
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Visually check the radiator and fluid level
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Enter the hours
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Windshield, Glass & Screens
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Windshield Wipers
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Steps
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Are grab bars present and in good condition
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Engine Compartment Cleanliness
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Check Engine oil
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How much Engine oil did you add
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Is the air filter clean
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take necessary steps so that you can answer yes
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Check Hydraulic fluid
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How much Hydraulic fluid did you add
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Are tracks clean
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Clean tracks
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Track pads
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Track tension
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Drive sprocket and wheels
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Blade
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Cutting edge condition (more than 1" of cutting edge below base metal)
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Blade Hoses
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Hydraulic rams and hoses
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Machine Greased
Interior
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Inside Appearance (housekeeping)
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Is the owners manual with the machine
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Is there an current Annual Inspection for this machine
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Is the fire extinguisher present and have a current inspection
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Take a picture of the tag
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Seat condition and Seat belt
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Start Machine
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Travel alarm - Back-up alarm audible when machine is running at full power
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Headlights operational
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Enter the hours
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Are all gauges, switches, and electrical components functioning
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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)
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Check fuel level - Fill when less than 1/4
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Please add proper fuel
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Check engine oil - Check oil before starting engine or at least 5 minutes after engine has stopped. Never mix two different types of oil
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Add oil to proper level
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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
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Add brake fluid to proper level
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Check coolant level
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Add coolant to proper level
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Clean grill/radiator screen Remove all foreign materials
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Check brake and speed control pedal - Ensure free travel and smooth operation
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Check indicators, gauges and meter
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Enter Hours
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Check lights
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Check seat belts
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Check front and rear joint boots - Check boots for cuts, cracks or deterioration
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Check tire pressure
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Inflate tires to proper PSI
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Check backup alarm
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Check DANGER, WARNING CAUTION Labels
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Sign only:
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TIRES OR TRACKS CUTS / WEAR / ETC
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Assign an action to the appropriate personnel
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Check Engine oil level
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Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item
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HOSES (Hydraulic, coolant)
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Fuel System
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Air filter
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Check Antifreeze overflow tank level or check radiator when cold if not equipped with an overflow
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Belts
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Check Hydraulic oil
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Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item
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Check Transmission oil
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Make necessary adjustments to make this item compliant and if you cannot remedy then create an action item
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Are the any visible leaks
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EXHAUST SYSTEM
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FRAME / SHEET METAL/BACK DOOR
- Good
- Fair
- Poor
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GRAB HANDLES
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MACHINE STEPS / BUCKET STEPS / NONSKID TAPE
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LIGHTS / BEACON Present and free of damage
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CAB / ROPS / FOP
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AUXILIARY HYDRAULIC QUICK COUPLERS
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ATTACHMENTS
Inside Cab
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OPERATOR’S MANUAL
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Is the annual inspection current on this equipment
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FIRE EXTINGUISHER
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Take a picture of the inspection tag including the gauge
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SAFETY DECALS PRESENT
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Start Machine
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Is the glass free of cracks
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OPERATOR'S SEAT BELT
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EQUIPMENT HOURS
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GAUGES / SWITCHES / ELECTRICAL
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HORN
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LIGHTS/BEACON
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ANY DASH/DISPLAY WARNING LIGHTS OR CODE
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STEERING / BRAKES / LEVERS functioning normally
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BACKUP ALARM
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Loader is in acceptable working condition
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Is the electrical cable in good condition? (No cuts or exposed wires)
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Is the generator properly grounded?
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Work with supervisor to obtain a proper ground before continuing use of Dust Boss
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Is water source properly connected with no leaks?
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Do what is necessary to minimize leaks
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Is Pump working properly?
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Is Oscillator working properly?
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Is Fan working properly?
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Are all spray nozzles clean and spraying
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Work with supervisor on how to clean the spray nozzles
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Please remember to drain the water from the Dust Boss at end of day
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If you do not know how to complete, ask your supervisor.