Title Page

  • Conducted on

  • Prepared by

  • Employee Number

  • Shift

  • Location

Equipment Information

  • Equipment Number

  • Does equipment have an hour meter or an odometer?

  • Hours

  • Miles

Checklist

  • Type of equipment

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Bucket

  • Dash Warning Lights

  • Electrical System

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Steps/Ladders

  • Track/Side Frame

  • Transmission

  • Warning Labels/ROPS Tags

  • Wipers

  • Wire Rope/Cables

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Bucket

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Brake Systems

  • Dash Warning Lights

  • Dump Body

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Steps/Ladders

  • Track/Side Frame

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheel Chocks

  • Wipers

  • Wire Rope/Cables

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Track/Side Frame

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Blade

  • Brake Systems

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Track/Side Frame

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Blade

  • Brake Systems

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Blade

  • Brake Systems

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Brake Systems

  • Bucket/Blade/Cutting System

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Track/Side Frame

  • Warning Labels/ROPS Tags

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Brake Systems

  • Bucket/Blade/Cutting System

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Wire Rope/Cables

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Wire Rope/Cables

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Brake Systems

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Dash Warning Lights

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Air Conditioning/Heater

  • All Lights

  • Auto-Lube

  • Back-Up Alarm/Horn

  • Boom/Mast

  • Brake Systems

  • Bucket/Blade/Cutting System

  • Buggy Whip/Strobe Light

  • Dash Warning Lights

  • Dump Body

  • Electrical System

  • Engine

  • Fire Extinguisher(s)

  • Fluid Leaks

  • Fuel leak

  • Gauges/Instruments

  • Glass - Doors/Cab/Mirrors

  • Housekeeping

  • Hydraulic System

  • Inside Door Handles

  • Outside Door Handles

  • Pneumatic Systems

  • Radio/Dispatch

  • Seat

  • Seat Belts

  • Steps/Ladders

  • Track/Side Frame

  • Transmission

  • Warning Labels/ROPS Tags

  • Wheels/Tires

  • Wheel Chocks

  • Wipers

  • Wire Rope/Cables

  • Document any defects or items needing repair.

  • Item
  • Defect or repair

  • Picture of defect or repair needed

  • Do not operate the equipment and red tag if any of the following items are deficient:

    Back-up Alarm/Horn
    Dash Warning Lights
    Fire Extinguisher
    Brake Systems/Brake Lights
    Inside Door Handles
    Turn Signals
    Fuel Leak
    Steering
    Seat Belt
    Head Lights
    Parking Brake
    Speedometer

  • Supervisor/Mechanic safety notification items:

    Buggy Whip/Strobe Light
    Cracked Glass
    Door Windows
    Warning Labels/ROPS Tags
    Fluid Leaks
    Heater/Defroster
    Outside Door Handles
    Windshield Wipers
    Radio
    Mirrors
    Oil Leak
    Tires

Signature

  • Operator Signature

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.