Title Page

  • Document No.

  • Line

  • Station

  • Station

  • Station

  • Station

  • Station

  • Conducted on

  • Prepared by

  • Click on "Add Coupler box" to assess the next Coupler box at the next station or platform. This will be above the previous one.

  • Add Coupler box to assess and record condition

  • Coupler Box
  • Code on front of box

  • Station and platform it's installed at

  • Location of coupler box if GPS enabled.
  • Use multiple selection to describe any damage

  • Overall Condition Rating of Box

  • Is the adaptor present and all 3 parts there

  • Are 2 hoses present

  • Is the trolley present?

  • Does the lock mechanism operate properly?

  • Take photos of box and contents inside, recording any damage

  • Record any maintenance or issues that need addressing

  • Notes

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.