Title Page

  • Conducted on

  • Prepared by

  • Location
  • Customer

  • H&S shipping number (ex. 41111)

  • Inspection type

  • Model

  • Serial number (ex. 190000)

  • Operational hours

  • Last engine service

  • Last hydraulic service

  • Operational manual

Outside machine

  • Cleanliness

  • Function/ operation

  • Safety decals

  • Doors and body

  • Lifting points

  • Tie down points

  • Steps & walkways

  • Door vents

  • Paint & finish

Mixer

  • Cleanliness

  • Function/ operation

  • Transportation locks

  • Tank condition

  • Tank adjustment rods

  • Mixing motor function & speed control

  • Mixer motor bearings

  • Impeller condition

  • Mixer lid & covers

  • Mixer cover safety switches

  • Latches & handles

  • Load cell function

  • Proper greasing

  • Paint and finish

Reservoir

  • Cleanliness

  • Function/ operation

  • Tank condition

  • Flow rake & floor scraper

  • Intake basket

  • Suction basket

  • Resevior lid & covers

  • Reservoir cover safety switches

  • Sonar sensor

  • Latches & handles

  • Paint & finish

Delivery pump

  • Cleanliness

  • Function/ operation

  • Safety covering

  • Seals of delivery pump

  • Suction balls & seats

  • Pressure balls & seats

  • Delivery pump pressure gauge

  • Hydraulic pistons

  • Delivery ball valves

  • Piston oil bags

  • Automatic lubrication greasing pump (engine compartment)

  • Adjustable delivery pressure valve

  • Bypass hose & ball valve

  • Paint & finish

Water tank & Pressure washer

  • Cleanliness

  • Function/ operation

  • Water tightness (no leaks)

  • Water fill level indicator tag

  • Water metering & float

  • Sensor water minimum

  • Sensor screw conveyor on

  • Sensor water maximum

  • Water distributor connections

  • Pressure washer function

  • Adjustable pressure relief

  • Pressure washer oil level

  • Pressure washer pistol

  • Pressure washer hose

  • Pipe cleaning hose

  • Paint & finish

Air compressor & air tank

  • Cleanliness

  • Function & operation

  • Air tank condition

  • Water/ air drain

  • Pressure gauge

  • Air connections (pneumatic vibrators)

  • Air hoses

  • Pneumatic valves

  • Pneumatic swing drive valves (check labels)

  • Paint & finish

Mixer accessories

  • Tool kit

  • Silo & bag breaking cover

  • Water inlet adapter

Hydraulic system

  • Cleanliness

  • Function/ operation

  • Hydraulic oil level

  • Hydraulic filters

  • Hydraulic pressure manometers

  • Hydraulic screw conveyers hook ups

  • Hydraulic and product hoses

  • Hose & camlock fittings

Electrical system

  • Cleanliness

  • Function/ operation

  • Emergency stops

  • Main battery switch

  • Battery (12V!!)

  • Battery fuse station

  • Engine control panel

  • Engine malfunctions

  • Engine service reminder accurate

  • Mixer control panel & covering

  • Touch screen condition/ function

  • Touch screen pencil

  • Control buttons and dials

  • Machine control panel & covering

  • Control buttons and switches

  • Interior & exterior lighting

  • Cabled delivery pump remote control

  • Extension cable drum

  • Wireless delivery pump remote control

  • Extra batteries & charges

  • Electrical screw conveyor electric transfer boxes

Engine system

  • Cleanliness

  • Function/ operation

  • Engine oil level

  • Engine service filters

  • Engine fuel system

  • Engine fan coolers

  • Coolant system and level

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.