Information

  • Document No.

  • Year - Make - Model - S/N

  • Customer

  • Conducted on

  • Evaluator

  • Location

OVERALL

  • Pictures of Equipment: Left, Right, Front, and Back

Engine

GRADING SCALE: 5 - Excellent Condition. New or recently replaced parts. 4 - Operates Well. Shows less than average wear. 3 - Operates. Is in average condition for age and hours. Minimal repairs. 2 - Operates but needs repair 1 - Repairs necessary prior to use

  • Engine Hours:

  • Fluid Level:

  • Condition:

  • Perform Oil Sample:

  • Engine Noise:

  • Color of Smoke:

  • Engine Smoke:

  • Visible Leaks?

  • Condition of Gauge Instruments:

  • Condition of Belts?

  • Condition of Pulleys?

  • Idle and Throttle Quality

  • Engine Mounts and Slides:

  • Radiator / Hoses:

  • Any Missing Parts:

Safety Equipment

  • Operator Presence Switch:

  • Operator Switch Functional:

  • Rubber Skirts Present:

  • Rubber Skirts Condition:

  • Safety Switch:

  • Safety Switch Condition:

  • Track Chain Rollers:

  • Red Safety Bars/ E-stops:

  • Work Lights Operational:

  • Running Lights Operational:

  • Red Safety Bars/ E-stops:

  • Decals in Place/ Legible:

  • Any Missing Parts:

Body Panels:

  • Paint:

  • Panels Dents:

  • Safety Shield/ Glass:

  • Condition:

  • Rust:

  • Frame:

  • Any Missing Parts:

Operation Function:

  • Throttle Control Front & Rear:

  • Drive Belt/ Drive Chain:

  • Drive Shaft:

  • Blades and Cutter Bar:

  • Cutter Drum/ Disc Condition:

  • Cutter Drum Bearings/ Disc:

  • Hammers:

  • Feed Rollers:

  • Feed Roller Slides:

  • Feed Roller Springs:

  • Feed Table Door:

  • Discharge Conveyor:

  • Conveyor Rollers:

  • Conveyor Belts:

  • Chute Turns:

  • Chute Deflector:

  • Winch/ Winch Line:

  • Smart Feed:

  • Auto Feed:

  • Auto Sweep:

  • Clutch/ Actuator:

  • Cutter Wheel/ Bearings Top/ Bottom:

  • Teeth:

  • Pockets / Bolts:

  • Console Pivots:

  • Levers Self-Center:

  • All Control Function:

  • Chip Blade:

  • Hitch Style:

  • Condition:

  • Jack and Handle:

  • Lights:

  • Control Panel Condition:

  • Any Missing Parts:

Ground Drive

  • Ground Drive Type:

  • Right Track Forward/ Reverse:

  • Track Chain Rollers:

  • Check Track Sprockets:

  • Left Track Forward/ Reverse:

  • Track Chain Rollers:

  • Check Track Sprockets:

  • Rollers:

  • Rubber Pads:

  • Track Adjustments:

  • Track Extensions:

  • Track Conditon:

  • Track Frame Cracks, Repairs:

  • Rollers/ Idlers:

  • Sprockets:

  • Brake Condition:

  • Any Missing Parts:

  • Tire Condition:

  • Tire Size:

  • Sprockets:

  • Mud Flaps:

  • Brakes:

  • Forward/Reverse Functions:

  • Planetary Chain:

  • Condition:

  • Drive Chain:

  • Condition:

  • Any Missing Parts:

Frame

  • Tilt Cylinder:

  • Tilt Pivot/ Pin Wear:

  • Swing Condition:

  • Any Cracks:

  • Horizontal, Vertical Pin Wear

  • Any Missing Parts?

Hydraulic System:

  • Hydraulic Fluid Level:

  • Hydraulic Fluid Condition:

  • Pump/ Pressure/ Flow Measured in PSI:

  • Visible Leaks:

  • Cylinders:

  • Hydraulic Motors:

  • Hoses And Fittings:

  • Operation of Controls:

  • Hydraulic Tank and Caps:

  • Perform Oil Sample:

  • Notes:

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.