HEO Loaned Equipment Usage

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Property/Equipment Usage LOCATION

• Start Date

  Date

• INSTRUCTOR(S)

• It is VERY important that this form be completely filled out upon the arrival & departure of ALL equipment. This form is to be used as an instructional tool for the Heavy Equipment Operators program (HEO). In order to ensure proper maintenance and insurance coverage for your property/equipment while being used as a teaching resource by Olds College; we would appreciate your assistance with providing the following information:

SPONSORS CONTACT INFORMATION

• Company

• Company Contact

• Phone

• E-Mail

EQUIPMENT DESCRIPTION(GENERAL)

• Equipment Type:

  Select Dozer Loader Grader Skid Steer Rubber Tire backhoe Excavator

  • Dozer
  • Loader
  • Grader
  • Skid Steer
  • Rubber Tire backhoe
  • Excavator

• Year : Make

• Model: Serial No:

• Hours at Arrival

PROPERTY/EQUIPMENT: (Fair Market Value)

• TIMEFRAME: Equipment will be under the direction & care of Olds College Staff

• Arrival Date:

  Date

• DELIVERED by:

• Hours at Last Service

• Next Service due at:

• Operators Manuals have been supplied

  YES

  NO

• Inspected by

• Arrival Evaluator Comments

INSPECTION AT ARRIVAL

• Tires,Wheels,Lug Nuts, Stem Caps ( inflation, leaks, damage)

  Yes

  No

  N/A

• Fenders, Bumper ( wear/ damage)

  Yes

  No

  N/A

• Main Body (wear/ damage)

  Yes

  No

  N/A

• Lift and Tilt Cylinders, Lines, Hoses ( wear, damage, leaks)

  Yes

  No

  N/A

• Frame, Push Arms ( wear/ damage)

  Yes

  No

  N/A

• Articulation area, joints, pins, steering cylinders, driveline and underside of cab (leaks/ damage)

  Yes

  No

  N/A

• Transmission, Transfer Case (leaks)

  Yes

  No

  N/A

• Steps and Handholds ( condition, cleanliness)

  Yes

  No

  N/A

• Fuel Tank ( level, damage, leaks)

  Yes

  No

  N/A

• Differential Oil (fluid level)

  Yes

  No

  N/A

• Axles – Final Drives, Differentials, Brakes, Duo-cone Seals (leaks, damages, wear)

  Yes

  No

  N/A

• Hydraulic Tank ( level, damage, leaks)

  Yes

  No

  N/A

• Hydraulic Lines ( condition, leaks, damage)

  Yes

  No

  N/A

• Transmission Oil ( fluid level)

  Yes

  No

  N/A

• Lights, Front and Rear ( working)

  Yes

  No

  N/A

• Battery Compartment ( Cleanliness, loose nuts & bolts)

  Yes

  No

  N/A

• Cutting Edges (% remaining)

  Yes

  No

  N/A

• Frog(Moldboard) (damage)

  Yes

  No

  N/A

ENGINE COMPARTMENT

• Engine Oil (fluid level)

  Yes

  No

  N/A

• Engine Coolant (fluid level)

  Yes

  No

  N/A

• Radiator(fin blockages,leaks)

  Yes

  No

  N/A

• All Hoses(cracks,wear,spots,leaks)

  Yes

  No

  N/A

• Fuel Filters / Water Separator(leaks/drain water)

  Yes

  No

  N/A

• All Belts(tension,wear,cracks)

  Yes

  No

  N/A

• Air Filter(restriction indicator)

  Yes

  No

  N/A

• Overall Engine Compartment(trash or dirt buildup, leaks)

  Yes

  No

  N/A

ON THE MACHINE, OUTSIDE THE CAB

• Handholds (condition and cleanliness)

  Yes

  No

  N/A

• ROPS (damage, loose mounting bolts)

  Yes

  No

  N/A

• Fire Extinguisher/System ( charge, damage)

  Yes

  No

  N/A

• Windshield, Windows ( broken glass, cleanliness)

  Yes

  No

  N/A

• Windshield Wipers / Washers (wear, damage, fluid level)

  Yes

  No

  N/A

• Doors (open properly, broken glass)

  Yes

  No

  N/A

INSIDE THE CAB

• Seat (condition, adjustable)

  Yes

  No

  N/A

• Seat Belt & Mounting ( damage, wear, adjustment, age)

  Yes

  No

  N/A

• Horn, Backup Alarm, Lights ( proper function)

  Yes

  No

  N/A

• Mirrors ( damage)

  Yes

  No

  N/A

• Cab Air Filter ( dirt, dust)

  Yes

  No

  N/A

• Gauges, Indicators, Switches, Controls ( damage, function)

  Yes

  No

  N/A

• Overall Cab Interior ( cleanliness)

  Yes

  No

  N/A

Departure

• Departure Date:

  Date

• Hours

• Inspected by

  Sign

• Departure Evaluator Comments

INSPECTION AT DEPARTURE

• Tires,Wheels,Lug Nuts, Stem Caps ( inflation, leaks, damage)

  Yes

  No

  N/A

• Fenders, Bumper ( wear/ damage)

  Yes

  No

  N/A

• Main Body (wear/ damage)

  Yes

  No

  N/A

• Lift and Tilt Cylinders, Lines, Hoses ( wear, damage, leaks)

  Yes

  No

  N/A

• Frame, Push Arms ( wear/ damage)

  Yes

  No

  N/A

• Articulation area, joints, pins, steering cylinders, driveline and underside of cab (leaks/ damage)

  Yes

  No

  N/A

• Transmission, Transfer Case (leaks)

  Yes

  No

  N/A

• Steps and Handholds ( condition, cleanliness)

  Yes

  No

  N/A

• Fuel Tank ( level, damage, leaks)

  Yes

  No

  N/A

• Differential Oil (fluid level)

  Yes

  No

  N/A

• Axles – Final Drives, Differentials, Brakes, Duo-cone Seals (leaks, damages, wear)

  Yes

  No

  N/A

• Hydraulic Tank ( level, damage, leaks)

  Yes

  No

  N/A

• Hydraulic Lines ( condition, leaks, damage)

  Yes

  No

  N/A

• Transmission Oil ( fluid level)

  Yes

  No

  N/A

• Lights, Front and Rear ( working)

  Yes

  No

  N/A

• Battery Compartment ( Cleanliness, loose nuts & bolts)

  Yes

  No

  N/A

• Cutting Edges ( wear left)

  Yes

  No

  N/A

• Frog(Moldboard) (damage)

  Yes

  No

  N/A

ENGINE COMPARTMENT

• Engine Oil (fluid level)

  Yes

  No

  N/A

• Engine Coolant (fluid level)

  Yes

  No

  N/A

• Radiator(fin blockages,leaks)

  Yes

  No

  N/A

• All Hoses(cracks,wear,spots,leaks)

  Yes

  No

  N/A

• Fuel Filters / Water Separator(leaks/drain water)

  Yes

  No

  N/A

• All Belts(tension,wear,cracks)

  Yes

  No

  N/A

• Air Filter(restriction indicator)

  Yes

  No

  N/A

• Overall Engine Compartment(trash or dirt buildup, leaks)

  Yes

  No

  N/A

ON THE MACHINE, OUTSIDE THE CAB

• Handholds (condition and cleanliness)

  Yes

  No

  N/A

• ROPS (damage, loose mounting bolts)

  Yes

  No

  N/A

• Fire Extinguisher/System ( charge, damage)

  Yes

  No

  N/A

• Windshield, Windows ( broken glass, cleanliness)

  Yes

  No

  N/A

• Windshield Wipers / Washers (wear, damage, fluid level)

  Yes

  No

  N/A

• Doors (open properly, broken glass)

  Yes

  No

  N/A

INSIDE THE CAB

• Seat (condition, adjustable)

  Yes

  No

  N/A

• Seat Belt & Mounting ( damage, wear, adjustment, age)

  Yes

  No

  N/A

• Horn, Backup Alarm, Lights ( proper function)

  Yes

  No

  N/A

• Mirrors ( damage)

  Yes

  No

  N/A

• Cab Air Filter ( dirt, dust)

  Yes

  No

  N/A

• Gauges, Indicators, Switches, Controls ( damage, function)

  Yes

  No

  N/A

• Overall Cab Interior ( cleanliness)

  Yes

  No

  N/A