Loader - Dispatch Form - On Hire Inspection

• Site conducted

  Select

• Plant ID

• Customer

• Project

• Conducted on

  Date

• Name of Inspector

• Location
  Address

• Machine Make And Model

• Equipment Serial Number

• Compliance Plate

  Yes

  No

  N/A

• Photo

  Media

• Registration Plate

  Yes

  No

  N/A

• Photo

  Media

• Machine Hours

• Photo

  Media

• Fuel Level %

GPS Tracking System Check

• Is the machine fitted and reporting?

  Yes

  No

• Does the meter reading match the portal?

  Yes

  No

Attachments

• Broom

• Photo

  Media

• Fork

• Photo

  Media

• Jib

• Photo

  Media

PHOTOS

• Front View

  Media

• Right Hand Side View

  Media

• Rear View

  Media

• Left Hand Side View

  Media

• Attachments

  Media

• Inside Cab

  Media

• Meter Reading

  Media

• Any Damage Evident

  Media

ENGINE

• Correct Coolant Level / Condition

  OK

  Needs Attention

  N/A

• Radiator Core / Clean

  OK

  Needs Attention

  N/A

• Cooling Lines

  OK

  Needs Attention

  N/A

• Fan Condition / Speed RPM

  OK

  Needs Attention

  N/A

• Belt Condition / Guarding

  OK

  Needs Attention

  N/A

• Coolant Leaks

  OK

  Needs Attention

  N/A

• Oil Leaks

  OK

  Needs Attention

  N/A

• Fuel Leaks

  OK

  Needs Attention

  N/A

• Drain Water Separators & Take Fuel Sample On Off Hire

  OK

  Needs Attention

  N/A

• Air Filters - Clean / Replace If Req.

  OK

  Needs Attention

  N/A

• Fuel Lines / Clamps

  OK

  Needs Attention

  N/A

• Engine Oil Level

  OK

  Needs Attention

  N/A

• Engine Operation & Shutdown

  OK

  Needs Attention

  N/A

• Air Intake Hose / Clamps

  OK

  Needs Attention

  N/A

• Air Filter Restriction Guage

  OK

  Needs Attention

  N/A

TRANSMISSION

• Correct Operation

  OK

  Needs Attention

  N/A

• Oil Level

  OK

  Needs Attention

  N/A

• Oil Leaks - Check Rubber Hose

  OK

  Needs Attention

  N/A

• Diff Locks

  OK

  Needs Attention

  N/A

HYDRAULIC SYSTEM

• Correct Oil Level

  OK

  Needs Attention

  N/A

• Oil Leaks

  OK

  Needs Attention

  N/A

BACKHOE / LOADER

• Out Rigger

  OK

  Needs Attention

  N/A

• Hitch Safety Pin

  OK

  Needs Attention

  N/A

• 4 Wheel Drive

  OK

  Needs Attention

  N/A

• Side Shift Locks

  OK

  Needs Attention

  N/A

• Auto Leveller

  OK

  Needs Attention

  N/A

• Chassis Cracks

  OK

  Needs Attention

  N/A

• Boom Stick Cracks

  OK

  Needs Attention

  N/A

• Hitch & Bucket Cracks

  OK

  Needs Attention

  N/A

ELECTRICAL

• UHF (Fitted Operational)

  OK

  Needs Attention

  N/A

• Mine Radio

  OK

  Needs Attention

  N/A

• AM / FM Stereo Fitted

  OK

  Needs Attention

  N/A

• Hour Meter Operational

  OK

  Needs Attention

  N/A

• Check All Lights Indicators Etc

  OK

  Needs Attention

  N/A

• Air Conditioner Operation

  OK

  Needs Attention

  N/A

• Gauges , Warning Alarms, EMS/CMS

  OK

  Needs Attention

  N/A

• Wipes/Washers - Washer Bottle Full-Fill & Test

  OK

  Needs Attention

  N/A

• Mirrors - Fitted & Free From Cracks

  OK

  Needs Attention

  N/A

• Reverse / Travel alarm fitted - must be squarker

  OK

  Needs Attention

  N/A

• Gauges

  OK

  Needs Attention

  N/A

• Battery Condition - Terminals - Clean If Necessary

  OK

  Needs Attention

  N/A

• E-Stop Cabin & Ground Level Fitted & Test To Be Working

  OK

  Needs Attention

  N/A

• Red Lockable Battery Isolator Fitted

  OK

  Needs Attention

  N/A

• Yellow Lockable Starter Isolator (Mine Spec)

  OK

  Needs Attention

  N/A

• Horn

  OK

  Needs Attention

  N/A

• Alternator - Record Output V

  OK

  Needs Attention

  N/A

• Amber Flashing Beacon (Fitted & Operational)

  OK

  Needs Attention

  N/A

CABIN

• Cab-Interior Detailed / Condition

  OK

  Needs Attention

  N/A

• Seat & Seat Belt

  OK

  Needs Attention

  N/A

• Steps / Hand Rails

  OK

  Needs Attention

  N/A

• Windows Clean / Free From Cracks

  OK

  Needs Attention

  N/A

• Seat Condition / All Operations & Seat Cover

  OK

  Needs Attention

  N/A

• Controls / Functions Labelled

  OK

  Needs Attention

  N/A

• First Aid Kit In Cab & Decal On Window

  OK

  Needs Attention

  N/A

• Check Cab Filters - Clean / Replace If Required

  OK

  Needs Attention

  N/A

• Operators Manual , Risk Assessment & Maintenance History

  OK

  Needs Attention

  N/A

• SVC Decals Fitted - Details of Next SVC - Advise supervisor if under 100hrs

  OK

  Needs Attention

  N/A

• Door, Seals And Windows

  OK

  Needs Attention

  N/A

MACHINE

• General Appearance

  OK

  Needs Attention

  N/A

• Brake Operation

  OK

  Needs Attention

  N/A

• Tyre Pressure / Condition

  OK

  Needs Attention

  N/A

• Safety Decals / Call Sign

  OK

  Needs Attention

  N/A

• Mine Tape

  OK

  Needs Attention

  N/A

• Handrails, Steps & Access Ways

  OK

  Needs Attention

  N/A

• Fire Extinguisher (Tag In Date)

  OK

  Needs Attention

  N/A

• Fire Suppression System (Tag In Date)

  OK

  Needs Attention

  N/A

• Auto Lube - Condition / Full

  OK

  Needs Attention

  N/A

• Check Steering & Articulation Lock Fitted

  OK

  Needs Attention

  N/A

• Supplied: Grease Gun

  Yes

  No

  N/A

• Supplied: Cartridges x 6

  Yes

  No

  N/A

• Supplied: Shifter

  Yes

  No

  N/A

• Supplied: Rags

  Yes

  No

  N/A

• Any Further Notes:

• Record Damage

TYRE REPORT

• POS 1 - Brand

• POS 1 - Size

• POS 1 - Serial Number

• POS 1 - RIM Serial Number

• POS 1 - TRA

• POS 1 - Inside - mm

• POS 1 - Outside - mm

• Photo - POS 1

  Media

• POS 2 - Brand

• POS 2 - Size

• POS 2 - Serial Number

• POS 2 - RIM Serial Number

• POS 2 - TRA

• POS 2 - Inside - mm

• POS 2 - Outside - mm

• Photo - POS 2

  Media

• POS 3 - Brand

• POS 3 - Size

• POS 3 - Serial Number

• POS 3 - RIM Serial Number

• POS 3 - TRA

• POS 3 - Inside - mm

• POS 3 - Outside - mm

• Photo - POS 3

  Media

• POS 4 - Brand

• POS 4 - Size

• POS 4 - Serial Number

• POS 4 - RIM Serial Number

• POS 4 - TRA

• POS 4 - Inside - mm

• POS 4 - Outside - mm

• Photo - POS 4

  Media

SIGN OFF

• Signature of Inspector

  Sign