Lakes Gas - Pre-Winter Delivery Truck Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• DM: PRE-WINTER DELIVERY TRUCK INSPECTION
  

• Select date

  Date

• Branch Number/Location:

• Truck Number:

Topic of Inspection

• Cargo Tank % Gauge/Thermometer Working?<br>

  Yes

  No

  N/A

• ESV Properly Working/Lubricated/Decaled?<br>

  Yes

  No

  N/A

• Fire Extinguisher Covered/Secured/Charged/Inspected?

  Yes

  No

  N/A

• Meter Register/Meter Door Secure/Lubricated?

  Yes

  No

  N/A

• Nozzle Secure and Capped?

  Yes

  No

  N/A

• Hose Reel Greased/Working/Chain/Sprocket?

  Yes

  No

  N/A

• Inlet Meter/Reel Valve and Pressure Gauge are Functioning?

  Yes

  No

  N/A

• Pump Greased?<br>

  Yes

  No

  N/A

• PTO/U-Joints/Couplers/Greased/Secured?<br>

  Yes

  No

  N/A

• Placards/VKIP Dates and Markings Current?<br>

  Yes

  No

  N/A

• Engine Oil Level/Dip Stick Reading?<br>

  Yes

  No

  N/A

• Tire Tread/Air Pressure/Lug Nuts/Indicators/Rims?<br>

  Yes

  No

  N/A

• Springs/Shackles/Leaf Integrity - Greased?<br>

  Yes

  No

  N/A

• Windshield Washer Level Full/Capped?<br>

  Yes

  No

  N/A

• Radiator/Fluid/Cap/Hoses/Clamps?<br>

  Yes

  No

  N/A

• Batteries Secured?<br>

  Yes

  No

  N/A

• Battery Terminals Clean/Secured?<br>

  Yes

  No

  N/A

• Doors/Locks/Door Hinges Tight/Secure/Lubricated?<br>

  Yes

  No

  N/A

• Running Boards/Step Tread Grip/Grab Rail?<br>

  Yes

  No

  N/A

• Windows Clean/Working/Lubricated?<br><br>

  Yes

  No

  N/A

• Mirrors Clean/Serviceable?<br>

  Yes

  No

  N/A

• Serviceable Block Heater System?<br>

  Yes

  No

  N/A

• Winter PVM by Shop Completed?<br>

  Yes

  No

  N/A

• Start Up Easy?<br>

  Yes

  No

  N/A

• Lights Clean/Working/Intact?<br>

  Yes

  No

  N/A

• Windshield Wiper Condition and Functioning?<br>

  Yes

  No

  N/A

• Defroster Fully Functioning/Unobstructed?<br>

  Yes

  No

  N/A

• Dash Clean, Free of Loose Items?<br>

  Yes

  No

  N/A

• Cab Organization, Clean, Prepared to Work?<br>

  Yes

  No

  N/A

• Shipping Papers/Proof Insurance/Registration?<br>

  Yes

  No

  N/A

• Del. Ticket Printer: Secured/Protected?<br>

  Yes

  No

  N/A

• Extra Delivery Tickets/Envelops/Pens?<br>

  Yes

  No

  N/A

• Warning and Gas Shut Off Tags (10 each)?

  Yes

  No

  N/A

• Triangle Reflective Markers?<br>

  Yes

  No

  N/A

• Flashlight Working?<br>

  Yes

  No

  N/A

• First Aid Kit Fully Intact and Maintained?<br>

  Yes

  No

  N/A

• Rubber Gloves Serviceable?<br>

  Yes

  No

  N/A

• Leak Detector/Leak Testing Equipment?<br>

  Yes

  No

  N/A

• Schrader Air Valves & 3/16 Allen Wrench?<br>

  Yes

  No

  N/A

• Extra Bleeder Plugs (min. 4)?<br>

  Yes

  No

  N/A

• ACME 1.75 & 1.25 Rubber Gaskets/Caps 5 ea.?<br>

  Yes

  No

  N/A

• Extra Prepared Regulators 1 ea. (1st/2nd Stage)?<br>

  Yes

  No

  N/A

• Company Hand Tools/Tool Box?<br>

  Yes

  No

  N/A

• Company Delivery Box?<br>

  Yes

  No

  N/A

• Working Hand Torch?<br>

  Yes

  No

  N/A

• ACME Spanner Wrench Condition?<br>

  Yes

  No

  N/A

• Shovel/Grit-Sand?<br>

  Yes

  No

  N/A

• Tire Mats?<br>

  Yes

  No

  N/A

• Additional Inspection Comments Here

• This vehicle has met all Company standards and is properly prepared for Winter Delivery/Service.

  Yes

  No

  N/A

• I certify this vehicle meets all DOT Compliance and is road worthy for Winter Delivery.<br><br>

  Yes

  No

  N/A