Loader 6/16

• Document No.

• Equipment # and Group Abbreviation

• Customer

  Chevron

  Aera

• Location

  Select Belridge (Aera) North Midway (Aera) South Midway (Aera) Kern River (CVX) Cymric (CVX) Midway (CVX) Coalinga

  • Belridge (Aera)
  • North Midway (Aera)
  • South Midway (Aera)
  • Kern River (CVX)
  • Cymric (CVX)
  • Midway (CVX)
  • Coalinga

• Work Group

  Select New Construction Maintenance Lead Line F/I DTR Infrastructure Developement I and E Production

  • New Construction
  • Maintenance
  • Lead Line
  • F/I
  • DTR
  • Infrastructure
  • Developement
  • I and E
  • Production

• EMC/IRT

  Select Belridge Coalinga/Kettleman Cymric Kern River Midway Ventura

  • Belridge
  • Coalinga/Kettleman
  • Cymric
  • Kern River
  • Midway
  • Ventura

• Foreman and or Superintendent

• Conducted on

  Date

• Auditor

  Brent Walker

  Orrin Bowen

  Jim Jensen

  Jerry Fannon

  William Craddock
• Location
  Address

• Is Loader cutting edge long enough ?

  Yes

  No

• Enter issues and include photo in media

• Add media

  Media

• Is the bucket worn ?

  No

  Yes

• Enter issues and include photos in media

• Add media

  Media

• All Zerks present and holding grease ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Are tires in good condition ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Are the bucket wear bits present and good condition ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Are there any hydraulic leaks from the rams or hoses ?

  No

  Yes

• Enter issues and include photos in media

• Add media

  Media

• Any fluid leaks from the engine ?

  No

  Yes

• Enter issues and include photo in media

• Add media

  Media

• All glass in good condition ? (cracks or missing) including front and rear wipers

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• All controls working properly ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Are seat belts in condition ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• All safety decals present and good condition ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Are all the lights working ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Operators manual in equipment ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Are the brakes working properly ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Is the back up alarm working ?

  Yes

  No

• Enter issues and include photos in media

• Add media

  Media

• Photo of preshift if there are repairs or if not filled out correctly

  Media

Employee Information

• EE Number

• Add signature

  Sign