Title Page
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Conducted on
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Prepared by
Hours
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Please enter the name of the employee, followed by their hours worked (Joe Smith - 8 hrs). Press ‘return’ between each entry.
Meter Readings
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Burner Hour Meter
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Plant Gas Meter
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Plant Fuel Meter
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Tank 1
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Tank 2
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Tank 3
Safety
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All Guards in Place
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Remarks
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All Plant Safety Signs in Place
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Remarks
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Oxygen and Gas Cylinders Properly Stored
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Remarks
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Aggregate Stockpiles Bermed (if app.)
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Remarks
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Correct PPE on hand and in use
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Remarks
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Loader Brake Check
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First Check
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Last Check
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Problem
Environmental
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Stack Appearance Clean
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Remarks
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Baghouse Controls/Gauges Functioning Properly
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Remarks
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Containment Area Clean
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Remarks
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Containers Properly Labeled
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Remarks
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Plant Area Clean
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Remarks
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Pump-off Area left CLEAN
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Remarks
Quality Control
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Tilcon Inspector
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State Inspector
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Other
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Customer Complaints/Returned Material (explain)
Maintenance and Repair
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Lubrication
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Repairs
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Breakdown Hours
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Explain
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O.T. Hours
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Explain
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Total Tons
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Weather
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Temperature
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RAP Tons
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Plant Operator
