loader 7/18/14

• Document No.

• Equipment #

• Customer

  Chevron

  Aera

• Location

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

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

• Brent Walker

  Orrin Bowen

  Jimbo Jensen

  Jerry Fannon

  Studs McCraddock
• Location
  Address

Bucket, Arm, and Ram Condition

• Are bucket wear bits present and in good condition ?

  Yes

  No

• Add media

  Media

• Is the bucket cutting edge and moldboard in good condtion ? (uneven wear or worn to bucket edge)

  Yes

  No

• Add media

  Media

• Are the bucket pivot pins in good shape ? (Greased and no free play)

  Yes

  No

• Add media

  Media

• Are all grease zerts present and holding grease ?

  Yes

  No

• Add media

  Media

• Are bucket lift and tilt cylinders in good shape ? (nicks, gouges, bent)

  Yes

  No

• Add media

  Media

• Are the hydraulic hoses to bucket rams in good shape ? (leaks, abrasons to hose)

  Yes

  No

• Add media

  Media

Chassis and External cab

• Are the steps and handholds in good and safe condition ?

  Yes

  No

• Add media

  Media

• Do all warning devices work ? (horn, backing horn, tail lamps)

  Yes

  No

• Add media

  Media

• Is the mirrors, glass, window locks and wipers in good condition ?

  Yes

  No

• Add media

  Media

• Is the chassis pivot pin greased and hydraulic hoses not leaking through chassis ?

  Yes

  No

• Add media

  Media

• Are all the external cab lights functional ?

  Yes

  No

• Add media

  Media

• Is cab securement bolts inspection marks aligned ?

  Yes

  No

• Add media

  Media

• Is there damage to tires, wheels or lug nuts

  No

  Yes

• Add media

  Media

Engine and Drivetrain condition

• Has the operator inspected the air filter during the pre shift?

  Yes

  No

• Add media

  Media

• Are all the fluids at correct level ? (oil, hydraulic, coolant)

  Yes

  No

• Add media

  Media

• Any leaks from engine compartment ?

  No

  Yes

• Add media

  Media

• Are there any hydraulic leaks ?

  No

  Yes

• Add media

  Media

• Any fuel leaks ?

  No

  Yes

• Add media

  Media

• Are the accessory belts in good condition ?

  Yes

  No

• Add media

  Media

• Are the drivelines in good shape ? (Clunks while moving forward and backwards)

  Yes

  No

• Add media

  Media

Interior and safety devices

• Is cab clean and free from clutter

  Yes

  No

• Add media

  Media

• Is owners manual present ?

  Yes

  No

• Add media

  Media

• Is there a fire extinguisher present and secure ?

  Yes

  No

• Add media

  Media

• Are all safety decals present and in good condition ?

  Yes

  No

• Add media

  Media

• Are all switches and lights functional ?

  Yes

  No

• Add media

  Media

General Condition

• Is this equipment in good working order ?

  Yes

  No

• Add media

  Media

• Does this equipment look clean and cared for ?

  Yes

  No

• Add media

  Media

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

  Media

Employee Information

• EE number

• Employee name

  Sign