Title Page
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Site conducted
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Vehicle ID
- MDA-TH01
- Borrowed Machinery From Another Company
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MDA Site Supervisor Gave Permission to Borrow Equipment From Another Company?
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Operator has current ticket or site specific VOC?
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Name of the Company
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Vehicle ID
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Machine Working Hours
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Conducted on
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Document Number
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Prepared by
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Shift
Checks Prior Starting Machinery
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Test for dead?
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Hydrolic Oil Level
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Engine Oil Level
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Transmition Oil Level
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Coolant Level
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Fan Condition
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Fan belts Condition
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No Leaks Inside Engine Bay
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No Leaks On Outside Of The Vehicle
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Tyre Condition (Thread Condition, No Cracks, No Foreign Objects, All Wheel Indicators Present and Facing Correct Way)
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Fire Extinguisher (Charged Within Limits, Safely Secured, Current Tag)
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Fire Supression (AFFF) (Charged Within Limits, Current Tag)
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Wheel Chocks (Operational and Available)
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Wipers Water Level
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Inspect Brackets
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Fuel Level
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Battery (Levels, Secured, Free of Corrosion)
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Wiring and Harness (Condition and Secured)
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First Aid Kit (Up To Date, Within Operator Reach)
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Two Way Radio (Operational, Radio Check Performed and Positive Communication received)
Inspections prior vehicle movement
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Service Brake Operational
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Emergency Brake Operational
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Park Brake Operational
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Steering Operational
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All hydraulic movements are operational
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UG Proxy Sensor Operational (light flashing on device)
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Horn Operational
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Reverse Alarm Operational
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Front Lights Operational
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Tail Lights Operational
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Indicators Operational
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Work Light Operational
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Spot Light Operational
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Condition Of Boom and Linkage
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Locking Pins Operational
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Seat Adjustment & Seat Belt Condition
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Counterweight Security
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Steps and Handrails
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Gauges Operational
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Air Conditioner Operational
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Wipers/Washers Operational
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No internal/external dents, scretches
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Lubrication Lines Operational
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Cab Cleanliness
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Windows cleanliness
Attachment - Bucket
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Are you gonna use bucket?
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Location of the bucket
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Bucket location
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Bucket damage
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Free of cracks, corrosion
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Pin Frame Operational
Attachment - Forks
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Forks Location
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Forks Free Of Damage
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Pin Plates Operational
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Fork Frame
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Tyne (free of cracks, dents, bents)
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Attachment Plate (conditon, free of crackes, dents)
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Slide Lock Operational
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Hydraulic Hoses and Fittings (free of leaks, no dirt inside fittings)
Attachment - Jib
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Jib Location
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Schakles Condition
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Jib Pin Frame Operational
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Swivel and hook Operational
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Attachment Point (free of damage)
Sign Off and Submit Page
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Additional Comments
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Signature
