UPC Service Pick-up Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Truck Documentation/Appearance

• Truck Number

• Truck has insurance card, current registration, operator's manual, and incident report form

  Yes

  No

  N/A

• Tag has current sticker

  Yes

  No

  N/A

• Truck is washed regularly

  Yes

  No

  N/A

• Windows, mirrors, dash, and cab are clean and free of clutter

  Yes

  No

  N/A

• Bed and storage bins are clean and free of debris

  Yes

  No

  N/A

• Body dents and dings are rare

  Yes

  No

  N/A

• Tires and rims are in good condition and properly inflated

  Yes

  No

  N/A

Safety Equipment

• Warning lights or strobes are well positioned and in proper working order

  Yes

  No

  N/A

• Work zone safety equipment is available and in good condition

  Yes

  No

  N/A

• Mounted or portable light is available

  Yes

  No

  N/A

• Vehicle has fire extinguisher with current annual inspection

  Yes

  No

  N/A

• First aid kit is properly stocked and checked weekly

  Yes

  No

  N/A

• Vehicle has 1 operational traffic cone

  Yes

  No

  N/A

• Brake, turning, running, and headlamp lighting is 100% operational

  Yes

  No

  N/A

• AED is inspected monthly and shows good batti

  Yes

  No

  N/A

Fall Arrest Equipment

• Harness has legible tag and is in good condition

  Yes

  No

  N/A

• Harness is stored in bag

  Yes

  No

  N/A

• Lanyard has legible tag and is in good condition

  Yes

  No

  N/A

• Buck/super squeeze is in proper working order, in good condition, and properly stored

  Yes

  No

  N/A

• Hooks are in proper working order, in good condition, and properly stored

  Yes

  No

  N/A

• Hand line is free of damage and properly stored

  Yes

  No

  N/A

PPE

• Rubber gloves and sleeves have current test date and are properly stored

  Yes

  No

  N/A

• Glove protectors show no signs of damage or wear

  Yes

  No

  N/A

• Hard hat and suspension are within suggested use range and are clean

  Yes

  No

  N/A

• Safety glasses are properly rated (z87.1) and stored in bag when not in use

  Yes

  No

  N/A

• Chaps are available and in good condition

  Yes

  No

  N/A

• Traffic vest is available and in good condition

  Yes

  No

  N/A

• Rain suit is available and in good condition

  Yes

  No

  N/A

• Personal grounds have current test date and are properly stored

  Yes

  No

  N/A

• Live line tools have current test date and are properly stored

  Yes

  No

  N/A

• Comments

• Additional Pictures

  Yes

  No

  N/A

• Inspector's Signature

  Sign