IPS Field Ticket Convoy management - Williamsport

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Convoy / Journey Management

• Trip date

  Date
• Starting Address
  Address
• Finish Address
  Address

• Weather conditions

Pre-departure paperwork checklist for trucks and tractors

• Has route been previously driven

  Yes

  No

  N/A

• Pre-trip inspections completed

  Yes

  No

  N/A

• Hazardous chemical

  Yes

  No

  N/A

• Is a pilot vehicle required

  Yes

  No

  N/A

• Discuss potential wildlife on road

  Yes

  No

  N/A

• Seat belts worn

  Yes

  No

  N/A

• Be polite and let traffic around you

  Yes

  No

  N/A

• Proper safety equipment on all vehicle

  Yes

  No

  N/A

• All drivers qualified to operate assigned vehicles

  Yes

  No

  N/A

• Drivers log books up to date

  Yes

  No

  N/A

• Route clearly defined and discussed

  Yes

  No

  N/A

• Map Available if required

  Yes

  No

  N/A

• Weather conditions discussed

  Yes

  No

  N/A

• Speed limit discussed

  Yes

  No

  N/A

• Planned stops discussed

  Yes

  No

  N/A

• Convoy procedures discussed

  Yes

  No

  N/A

• Convoy supervisor identified

  Yes

  No

  N/A

• All vehicles remain in site of convoy

  Yes

  No

  N/A

• All vehicles can communicate

  Yes

  No

  N/A

• Tractor paperwork complete

  Yes

  No

  N/A

• Trailer paperwork complete

  Yes

  No

  N/A

• Vehicles have an incident kit on board

  Yes

  No

  N/A

• Trip permit signed and M-938 form

  Yes

  No

  N/A

• Drivers by signing this document you are confirming that you and the vehicle you are about to operate are safe and compliant with state and federal DOT regulations.

• Supervisor Name and vehicle number

  Sign

• Coil Unit driver name and unit number

  Sign

• Pump unit driver name and number

  Sign

• Crane driver name and unit number

  Sign

• Bop unit driver name and unit number

  Sign