Hennigan Energy Service Group

• Site conducted

  Select

• Home Office Location Address

• Work Order Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Truck or Unit Number

• Mileage on Truck

• Air Compressor

  Pass

  Fail

  N/A

• Air Lines

  Pass

  Fail

  N/A

• Battery

  Pass

  Fail

  N/A

• Belts and Hoses

  Pass

  Fail

  N/A

• Body

  Pass

  Fail

  N/A

• Brake Accessories

  Pass

  Fail

  N/A

• Brakes, Parking

  Pass

  Fail

  N/A

• Brakes , Service

  Pass

  Fail

  N/A

• Clutch

  Pass

  Fail

  N/A

• Coupling Devices

  Pass

  Fail

  N/A

• Defrost, Heater

  Pass

  Fail

  N/A

• Drive Line

  Pass

  Fail

  N/A

• Engine

  Pass

  Fail

  N/A

• Exaust

  Pass

  Fail

  N/A

• Fifth Wheel

  Pass

  Fail

  N/A

• Fluid Levels

  Pass

  Fail

  N/A

• Frame and Assembly

  Pass

  Fail

  N/A

• Front Axle

  Pass

  Fail

  N/A

• Fuel Tanks

  Pass

  Fail

  N/A

• Lights

  Select

• Mirrors

  Pass

  Fail

  N/A

• Muffler and Exhaust

  Pass

  Fail

  N/A

• Oil Pressure

  Pass

  Fail

  N/A

• Radiator

  Pass

  Fail

  N/A

• Rear End

  Pass

  Fail

  N/A

• Reflectors

  Pass

  Fail

  N/A

• Starter

  Pass

  Fail

  N/A

• Steering

  Pass

  Fail

  N/A

• Suspension System

  Pass

  Fail

  N/A

• Tire Chains

  Pass

  Fail

  N/A

• Tires

  Pass

  Fail

  N/A

• Transmission

  Pass

  Fail

  N/A

• Trip Recorder

  Pass

  Fail

  N/A

• Wheel and Rims

  Pass

  Fail

  N/A

• Windows

  Pass

  Fail

  N/A

• Windshield Wipers

  Pass

  Fail

  N/A

• Other

Trailer Unit Number

• Break Connection

  Pass

  Fail

  N/A

• Breaks

  Pass

  Fail

  N/A

• Coupling Devices

  Pass

  Fail

  N/A

• Coupling(KING) Pin

  Pass

  Fail

  N/A

• Doors

  Pass

  Fail

  N/A

• Gates

  Pass

  Fail

  N/A

• Hitch

  Pass

  Fail

  N/A

• Landing Gear

  Pass

  Fail

  N/A

• Lights (ALL)

  Pass

  Fail

  N/A

• Reflectors and Reflective Tape

  Pass

  Fail

  N/A

• Roof

  Pass

  Fail

  N/A

• Floor

  Pass

  Fail

  N/A

• Suspension System

  Pass

  Fail

  N/A

• Tarpaulin

  Pass

  Fail

  N/A

• Tires

  Pass

  Fail

  N/A

• Wheel and Rims

  Pass

  Fail

  N/A

• Other

Descriptions of repairs and defects needing repair

• Defect

• Conditions of the above equipment are Satisfactory

  Sign

• The above defects have been corrected

  Date

• The above defects have been corrected By Mechanics Name

  Sign

• The above corrections need not be corrected for safe operation of the vehicle

  Yes

  No

  N/A

• Mechanic's Signature for safe operation of the above Vehicle

  Sign

• Date released by Mechanic

  Date

• Driver acceptance of the status for safe operation of the vehicle above

  Sign