Field Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

FLA/ROR Form

• Order#

• Date and time

  Date

• Drivers name

• Tractor#

• Location of inspection
  Address

• Operating area

• Trailer#

• Commodity

• UN#

• Onboard

  Select Loaded Empty Partial Load Parked Bob Tail

  • Loaded
  • Empty
  • Partial Load
  • Parked
  • Bob Tail

ROR section (Road Observation Report)

• Pace (km/h)

• Radar stationary (km/h)

• Radar Traveling (km/h)

• Legal Speed (km/h)

• Whether conditions

• Traffic

• Terrain

• Road conditions

• Light conditions

• Remarks

FLA observation Audit Level 1

• Unit properly positioned

  Select yes no

  • yes
  • no

• Ground cable attached properly

  Select yes no

  • yes
  • no

• All PPE worn properly

  Select yes no

  • yes
  • no

• Gas monitor worn and Bump tested

  Select yes no

  • yes
  • no

• Number of days Until next calibration due

• Proper safe work procedure followed

  Select yes no

  • yes
  • no

• Three point contact maintained

  Select yes no

  • yes
  • no

• Chock blocks (if required)

  Select yes no n/a

  • yes
  • no
  • n/a

• Non required electrical devices are shut off

  Select yes no

  • yes
  • no

• In attendance

  Select yes no

  • yes
  • no

• Tire chains

  Select yes no n/a

  • yes
  • no
  • n/a

• CVIP current

  Select yes no

  • yes
  • no

• Log book current and correct

  Select yes no

  • yes
  • no

• Bill of lading correct

  Select yes no OBC

  • yes
  • no
  • OBC

• Pre-trip inspection correct

  Select yes no

  • yes
  • no

• H2S certificate current

  Select yes no

  • yes
  • no

• WHIMIS and TDG certificate current

  Select yes no

  • yes
  • no

• Drivers licence current

  Select yes no

  • yes
  • no

• First aid certificate current

  Select yes no

  • yes
  • no

• ODA/PDIC certificate current

  Select yes no

  • yes
  • no

FLA level 2 inspection

• Insurance valid

  Select yes no

  • yes
  • no

• Registration valid

  Select yes no

  • yes
  • no

• Safety fitness certificate

  Select yes no

  • yes
  • no

• HSSE handbook present

  Select yes no

  • yes
  • no

• All permits current

  Select yes no

  • yes
  • no

• Fluid hose tests current and in good condition

  Select yes no

  • yes
  • no

• Customer sight orientation current

  Select yes no

  • yes
  • no

• SABA/SCBA in good working condition

  Select yes no n/a

  • yes
  • no
  • n/a

• Auto air shutdown switch available

  Select yes no

  • yes
  • no

• Auto air shutdown functional

  Select yes no

  • yes
  • no

• Lights working and clean

  Select yes no

  • yes
  • no

• No audible air leaks

  Select yes no

  • yes
  • no

• Locking cam locks on all hoses

  Select yes no n/a

  • yes
  • no
  • n/a

• Charged fire extinguisher and yearly inspection

  Select yes no

  • yes
  • no

• Placards in good condition and clean

  Select yes no

  • yes
  • no

• Wipers/washer functional

  Select yes no

  • yes
  • no

• Horn (air and steering wheel) Working

  Select yes no

  • yes
  • no

• Windshield condition

  Select Good needs Attention

  • Good
  • needs Attention

Evaluation

• Evaluation

  Select compliant non-compliant

  • compliant
  • non-compliant

Safety topic-mandatory

• Safety topic

Comments/suggestions

• Comments/suggestions

• Drivers name/signiture

  Sign

• Facilitators name/signiture

  Sign

Management Section

• Damerits

• Section

• Suspension Days Assigned

• Points

• Commendation Awarded

• Signiture

• Date