FORM: WHS-FO-005 Rev1

• Document No.

• Client / Site / Job No.#

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PLANT DETAILS

• Plant Type

• Make & Model

• Speedo/Hours

• Registration No.#

• Plant No.#

SERVICE DETAILS

• Service by:

• Service Hours / Speedo

• Next Service Due

• Service Frequency

• Qualifications

• Add signature

  Sign

DESCRIPTION

• Steam Clean

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

OILS

• Engine

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Transmission

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Differencial

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Power Steering

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Swing Oil

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Automatic Transmission Service

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

FILTERS

• Engine Oil

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Fuel

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Hydraulic

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Air

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

OTHER

• Brakes inc Fluid / Park Brake

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Repack wheel bearings

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Tune Up as Required

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Change Radiator Water/Inhibitor/Antifreeze

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Battery Condition Water

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Tyres Condition / Pressure

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Hoses Checked

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Belts Checked

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Under Carriage Check

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Lights / Indicators/ brake lights / Horn

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Final drive left and right

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Idlers

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Sprockets

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Rollers

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Chains

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Arm

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Bucket

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Boom

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comment

• Quick Hitch

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

• Cylinders

  Select Yes No NA Replace - Yes Replace - No

  • Yes
  • No
  • NA
  • Replace - Yes
  • Replace - No

• Comments

Additional Repairs carried Out

• Hours / Kms

• Comments / Recommendations

• Photos for any reason

  Media

SIGN OFF

• Name

• Add signature

  Sign