Initial Equipment Inspection

• Project Title:

  Santa Fe ACP Exit

• USACE Contract#

  W9126G20C1598

• Contractor:

• Conducted on

  Date

• Prepared by:

  SSHO-Jerry Word
• Location (Drop Pin for GPS & Address):
  Address

• Reason for Equipment Inspection:

  Premobilization

  Mobilization

  Annual Inspection

• Initial Inspection Date

  Date

• Annual Inspection Expires

  Date

• EQUIPMENT TYPE:

  Select Excavator Backhoe Dozer Loader Skid Loader Motor Grader Roller/Compactor Scraper Sweeper Water Truck Trencher Articulated Dump Truck Paver Dump Truck Boom Lift Scissor Lift Fork Lift Man Lift Cold Planer Light tower/Portable Generator Generator Welder Air Compressor Concrete Wet Saw Milling Machine / Cold Planers Box Blade Sky Jack Other

  • Excavator
  • Backhoe
  • Dozer
  • Loader
  • Skid Loader
  • Motor Grader
  • Roller/Compactor
  • Scraper
  • Sweeper
  • Water Truck
  • Trencher
  • Articulated Dump Truck
  • Paver
  • Dump Truck
  • Boom Lift
  • Scissor Lift
  • Fork Lift
  • Man Lift
  • Cold Planer
  • Light tower/Portable Generator
  • Generator
  • Welder
  • Air Compressor
  • Concrete Wet Saw
  • Milling Machine / Cold Planers
  • Box Blade
  • Sky Jack
  • Other

• MAKE & MODEL:

• EQUIPMENT ID/VIN:

  Media

• Hour Meter / Odometer:

• Owned by:

• In use by (company):

• Operated by (name of operator):

• Is operator qualified/authorized ?

  Pass

  Fail

  N/A

• Inspected by:

  Jerry Word

• Title & Employer

  Site Safety Officer / NNAC

• General Equipment Condition: ( if unacceptable explain in comments section )

  New

  Good

  Fair

  Poor

  Unacceptable

WALK AROUND VISUAL INSPECTION

• Please take photos of the front, rear, left and right side

  Media

• Any Visible Leaks (Check Hoses, Belly Pans, Ground)

  Yes

  No

  N/A

• Broken Glass

  Yes

  No

  N/A

• Body or Structural Damage

  Pass

  Fail

  N/A

• Tires /Inflated (Condition/Pressure)

  Pass

  Fail

  N/A

• Tracks/ Adjusted Properly (Check for Slack)

  Pass

  Fail

  N/A

• Mounted Fire Extinguisher, Charged, With Inspection Tag

  Compliant

  Non-Compliant

  N/A

• Mirrors (Missing or Damaged)

  Compliant

  Non-Compliant

  N/A

• Lights, Safety Beacon, Reflectors

  Compliant

  Non-Compliant

  N/A

• Ladders / Steps and Grab Rails

  Compliant

  Non-Compliant

  N/A

• Decals Installed and Legible

  Compliant

  Non-Compliant

  N/A

• Any loose parts/ guards or missing covers

  Yes

  No

  N/A

• Belts and Hoses Free of Wear and in Good Condition

  Yes

  No

  N/A

• Exhaust System (Any leaks, excessive smoking)

  Pass

  Fail

  N/A

• Batteries and Cables

  Pass

  Fail

  N/A

• Regulatory Inspection Current

  Compliant

  Non-Compliant

  N/A

• COMMENTS:

FLUID LEVELS

• Engine Oil

  Pass

  Fail

  N/A

• Transmission Fluid

  Pass

  Fail

  N/A

• Hydraulic Fluid

  Pass

  Fail

  N/A

• Coolant

  Pass

  Fail

  N/A

• Fuel

• Lubricants

  OK

  Service/Repair

  Unacceptable

  N/A

• COMMENTS:

ATTACHMENTS

• Cutting Edges / Teeth / Pins / Bushings etc.

  Good

  Fair

  Poor

  N/A

• Buckets / Blades

  Good

  Fair

  Poor

  N/A

• COMMENTS:

CAB OPERATIONAL CHECK

• Please take photos of the interior of the cab and any storage

  Media

• Cleanliness

  Good

  Fair

  Poor

  N/A

• Seat and Seatbelts

  Compliant

  Non-Compliant

  N/A

• Gauges and Instruments (Check for Normal Readings)

  Pass

  Fail

  N/A

• Controls and Levers (Check For Normal Operation)

  Pass

  Fail

  N/A

• Parking Brake

  Pass

  Fail

  N/A

• Service Brake

  Pass

  Fail

  N/A

• Emergency Shutdown

  Compliant

  Non-Compliant

  N/A

• Steering System

  Pass

  Fail

  N/A

• Heater and AC System

  Pass

  Fail

  N/A

• Horn, Back Up Alarms / Warning Devices

  Compliant

  Non-Compliant

  N/A

• Engine (Check For Any Unusual Sounds)

  Pass

  Fail

  N/A

• Hydraulic Mechanisms

  Pass

  Fail

  N/A

• Electrical Wiring

  Pass

  Fail

  N/A

• Charging System

  Pass

  Fail

  N/A

• Is equipment in safe operating condition?

  Yes

  No

  N/A

• Is the Manufactures Operator's Manual in the equipment cab?

  Yes

  No

  N/A

• Are Spill Kits in place?

  Yes

  No

  N/A

• COMMENTS:

SIGNATURES

• Operator's Signature:

  Sign

• SSHO Signature:

  Sign