Information
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Name of report:
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Document No.
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Conducted on
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Equipment #:
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Prepared by:
- Mark Davis
- Clyde Eppard
- Jason Corbin
- Anthony Beverly
- Richard Dickinson
- Lee Ratliff
- Michael Wright
- Scott Taylor
- Hugh French
- James Brown
- Chuck Ayers
- James Shifflett
- Gary Berghan
- Tom Chestnut
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Location (Drop Pin for GPS & Address):
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MAKE & MODEL:
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Hour Meter / Odometer:
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General Equipment Condition: ( if unacceptable explain in comments section )
- Good
- Fair
- Poor
- Unacceptable
WALK AROUND VISUAL INSPECTION
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Cleanliness
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Please take photos of the front, rear, left and right side
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Fluid Leaks
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Broken Glass
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Body or Structural Damage
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Tires / Tracks - Inflated / Adjusted Properly
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Fire Extinguisher Equipped and Charged
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Mirrors
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Mud Flaps
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Wipers, Lights, Reflectors
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Ladders / Steps and Grab Rails
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Decals Installed and Legible
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Loose Parts or Missing Covers
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Belts and Hoses Servicable
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Exhaust System
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Hydraulic Lines and Cylinders
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Batteries and Cables
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Broken Welds
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Regulatory Inspection Current
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Lug Nuts / Rims
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OTHER:
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COMMENTS:
FLUID LEVELS
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Engine Oil
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Transmission Fluid
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Hydraulic Fluid
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Coolant
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Fuel
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Lubricants
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COMMENTS:
CAB OPERATIONAL CHECK
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Please take photos of the interior of the cab and any storage
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Cleanliness
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Seat and Seatbelts
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Gauges and Instruments
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Controls and Levers
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Parking Brake
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Service Brake
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Limit of Safety Switches
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Emergency Shutdown
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Steering System
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Heater and AC System
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Horn, Warning Alarms / Devices
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Clutches
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Drives
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Transmission
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Engine
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Hydraulic Mechanisms
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Electrical Wiring
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Charging System
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Is equipment in safe operating condition?
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Is the Operator's Manual in the equipment cab?
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Are Spill Kits in place?
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OTHER:
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COMMENTS:
ATTACHMENTS
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Cutting Edges / Teeth / Pins / Bushings etc.
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Buckets / Blades
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COMMENTS:
SIGNATURES
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Operator's Signature:
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Foreman Signature:
