Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
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OPERATOR NAME & EMPLOYEE ID:
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EQUIPMENT MAKE AND MODEL:
HEAVY EQUIPMENT TYPE. (choose all that apply to this Operator)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
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QUALIFIED TO OPERATE:
- Track Hoe (ATIS#_81221)
- Roller (ATIS#_81230)
- Rough Terrain Forklift (ATIS#_81228)
- Articulating Boom Lift (ATIS#_81232)
- Amphibious Track Hoe (ATIS#_81222)
- Articulating Dump Truck (ATIS#_81233)
- Track Dozer (ATIS#_81223)
- Fuel Truck (ATIS#_81235)
- Water Truck (ATIS#_81234)
- Haul Truck (ATIS#_81236)
- Grader (ATIS#_81229)
- Back Hoe (ATIS#_81220)
- Wheel Loader (ATIS#_81231)
- orientation Completed (ATIS#_81197)
APPLICABLE PREREQUISITES (to be established by job site Foreman, Supervisor or Manager)
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Proof of State CDL Motor Vehicle License?
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Proof of S-5 Medical Exam (Required every 2 years) for TVA and Staff Augmented Drivers and Operators?
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Proof old DOT Physical (Required every 2 years) for Managed Task Drivers?
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Proof of Medical Certification for Operators provided by Managed Task Contractors or Union?
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Proof of HAZMAT Training (currently only required at KFP)?
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Operator has read the "Equipment Operator's Manual" and has agreed to follow all stated procedures, cautions and warnings?
TASK QUALIFIED - Maintenance Inspection
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Oil and Transmission Fluid Level?
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Fluid Level / correct fluid used?
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Hydraulic Fluid Level?
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Lubrication?
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Check for Fluid Leaks?
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Glass, Mirrors, Wipers, and Lights?
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Machine Clean?
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Tracks and Blades?
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Tire Pressure / Condition?
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Boom, Forks, and Outriggers?
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Roller Drum?
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Basket and Guardrails?
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Spill Kit?
TASK QUALIFIED - Site Conditions
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Inspection of no site conditions, wet, dry, or slick conditions, underground and overhead obstructions?
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Operator / Driver briefed on what to do in case of a spill or a leak?
TASK QUALIFIED - Access into Machine
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Face Machine using foot steps and hand hold while maintaining 3 points of contact?
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Check Emergency Brake and out of gear / seat belt secured?
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Door or chain to lift closed and secured?
TASK QUALIFIED - Equipment Operations
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Travel Foreward?
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Travel Reverse / Backup Alarm?
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Safe Travel Speed?
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Vehicle Lights and Flashers used?
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Machine Instrument Functions?
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Adjust Mirrors for Blind Spots?
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Adjust Blade Position?
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Adjust Bucket Position?
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Operate with Vibrator On?
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Raise and Lower Truck Bed?
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Apply Power Take-off (PTO) correctly?
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Extend Boom and Bucket?
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Pallet Fork Operation?
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Track Right and Left?
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Travel Up and Down Slopes?
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Side shift and rotate carriage?
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Pickup and Secure Load?
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Adjust Outriggers?
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Material Handling Arm Operation?
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Swing 360 Degrees?
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Use Front Wheel Drive?
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Use 4-Wheel Drive?
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Use Crab Drive?
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Maintain Max. Slope to 2:1 ?
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Lower and Set Load?
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OTHER
TASK QUALIFIED - Loading
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Understands Machine Capacity with various water levels, hooks, latches, and load charts?
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Proper Brake and Gear use to Slow and Stop Vehicle?
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All attachments approved by Manufacturer and within Loading Capacities?
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Proper Attachment Changing Procedures?
TASK QUALIFIED - Exiting from Machine
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Stop Machine, Secure Attachments, Place Bear in Neutral and Apply Parking Brake?
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Ground Condition Appropriate to Exit?
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Face Machine using Foot Steps and Hand Holds while Maintaining 3 Points of Contact?
SIGNATURES
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I (Operator/Driver) understand this checkout is for the above Make and Model.
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Operator/Driver Signature:
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Job Site Foreman, Supervisor or Manager Signature:
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Print Name of Signature above:
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The above signatures attest to the Makes & Models as specified above only. Changes in Make or Model that could impact safe operation of the equipment will require operator checkout by the responsible Supervisor.
