Off Road Heavy Equipment Initial Safety Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

W9126G-12-C-0015 OFF ROAD HEAVY EQUIPMENT INITIAL INSPECTION

• Initial Inspection Date

  Date

• Annual Inspection Expires?

• Type of equipment?

• Make/Model.

• Owner ID.

• Owned by:

• In use by (company):

• Operated by (name of operator): Employer :

• Operator qualified/authorized?

  Yes

  No

  N/A

• Photo of equipment

  Media

• Authorized by :

• Inspected by: (print)

• Add signature

  Sign

• Title and employer

Off-Road Heavy Equipment Inspection checklist

• Operator has reviewed charts & manuals and understands safe operating practices?

  Yes

  No

  N/A

• Operator does a Daily Equipment Inspection at the start of the shift?

  Yes

  No

  N/A

• Equipment is in proper condition for street use (turn signals, brake lights, etc.)

  Yes

  No

  N/A

• Back up alarm is functioning and loud enough for the conditions?

  Yes

  No

  N/A

• Warning horn is functioning and loud enough for the conditions?

  Yes

  No

  N/A

• Is there a charged fire extinguisher in the cab with current inspection tag?

  Yes

  No

  N/A

• Is the cab glass without cracks or damage?

  Yes

  No

  N/A

• Are steps and seat in proper condition?

  Yes

  No

  N/A

• Are seat belts provided and used properly?

  Yes

  No

  N/A

• Are riders permitted where there is no seat or seatbelt?

  Yes

  No

  N/A

• Is roll over protection (ROPS) provided?

  Yes

  No

  N/A

• Is Overhead protection provided?

  Yes

  No

  N/A

• Is protection from flying debris provided?

  Yes

  No

  N/A

• Is adequate lighting provided for work in low light/dark conditions?

  Yes

  No

  N/A

• Are breaks functioning properly?

  Yes

  No

  N/A

• Are beds of dump trucks equipped with device for locking body in raised position (for maintenance)?

  Yes

  No

  N/A

• Are tires/tracks in good condition?

  Yes

  No

  N/A

• Are pulleys, belts, gears, chains, and other nip and shear points adequately guarded?

  Yes

  No

  N/A

• Is fuel tank located to prevent spills and overflow from contacting hot parts or electrical equipment?

  Yes

  No

  N/A

• Are windshield wipers in good working order?

  Yes

  No

  N/A

• Is exhaust located/directed so as not to endanger workers or obstruct operator's view?

  Yes

  No

  N/A

• Are fuel cans approved safety type?

  Yes

  No

  N/A

• Have modifications to original equipment been made with manufacturers written approval?

  Yes

  No

  N/A