IPS pre-trip DOT yard/Wellsite audit

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Pre-Trip Safety

• 1. Is the convoy briefing complete?

  Yes

  No

  N/A

• 2. Is the vehicle Pre-Trip inspection complete

  Yes

  No

  N/A

• 3. Is the previous day post trip inspection signed?

  Yes

  No

  N/A

• 4. Tractor and trailer paperwork checked?

  Yes

  No

  N/A

• 5. Is the drivers log book up to date including past 7 days?

  Yes

  No

  N/A

• 6. Valid permit and m-938 form in truck?

  Yes

  No

  N/A

• 7. All emergency equipment checked?

  Yes

  No

  N/A

• 8. Cab house cleaning?

  Safe

  At Risk

  N/A

• 9. Current IFTA sticker on vehicle?

  Yes

  No

  N/A

• 10. Company name and DOT sticker on vehicle?

  Yes

  No

  N/A

• 11. Fire Extinguisher inside sticker present on vehicle and proper placement?

  Yes

  No

  N/A

• 12. License plate and tags current on vehicle?

  Yes

  No

  N/A

• 13. Condition of wind shield wipers checked?

  Yes

  No

  N/A

• 14. Wind shield washer fluid checked?

  Yes

  No

  N/A

• 15. Condition of mirrors checked?

  Yes

  No

  N/A

• 16. Tractor/ Trailer lights working and reflectors clean?

  Yes

  No

  N/A

• 17. Turn signals, brake and emergency lights working?

  Yes

  No

  N/A

• 18. Fuel tanks, caps and mounts checked?

  Yes

  No

  N/A

• 19. Placards and holders in place and visible?

  Yes

  No

  N/A

• 20. Mud flaps on tractor?

  Yes

  No

  N/A

• 21. Unit number on tractor and trailer?

  Yes

  No

  N/A

• 22. Cab to trailer line secured?

  Yes

  No

  N/A

• 23. Trailer plug and hitch secured properly?

  Yes

  No

  N/A

• 24. Tool box closed and latched?

  Yes

  No

  N/A

• 25. 20lbs fire extinguisher on trailer?

  Yes

  No

  N/A

• 26. Mud flaps on trailer?

  Yes

  No

  N/A

• 27. All materials and equipment secured by straps?

  Yes

  No

  N/A

• 28. No items attached or improperly secured that would make vehicle over width?

  Yes

  No

  N/A

• 29. MSDS Avalible?

  Yes

  No

  N/A

• 30. Fire extinguisher secured?

  Yes

  No

  N/A

• 31. Emergency breakaway device properly hooked up and functioning?

  Yes

  No

  N/A

• 32. Wheel chock on vehicle?

  Yes

  No

  N/A

• 33. Trailer safety chains crossed and hooked up properly?

  Yes

  No

  N/A

• Tractor and trailer number

Audit Certification.

• Driver comments

• Drivers Name

  Sign

• Auditor comments

• Auditor name

  Sign