Water Buffalo / Pipe Dolly 7/18

• Document No.

• Equipment # and Group Abbreviation

• Equipment attached to dolly/buffalo

• Customer

  Select Chevron Aera

  • Chevron
  • Aera

• Location

  Select Kern River (CVX) Belridge (Aera) North Midway (Aera) South Midway (Aera) Cymric (CVX) Midway (CVX) Coalinga

  • Kern River (CVX)
  • Belridge (Aera)
  • North Midway (Aera)
  • South Midway (Aera)
  • Cymric (CVX)
  • Midway (CVX)
  • Coalinga

• Work Group

  Select New Construction Maintenance Lead Line F/I DTR Infrastructure Developement I and E Production

  • New Construction
  • Maintenance
  • Lead Line
  • F/I
  • DTR
  • Infrastructure
  • Developement
  • I and E
  • Production

• EMC/IRT

  Select Belridge Coalinga/ Kettelman Cymric Kern River Midway Ventura

  • Belridge
  • Coalinga/ Kettelman
  • Cymric
  • Kern River
  • Midway
  • Ventura

• Foreman and or Superintendent

• Conducted on

  Date

• Auditor

  Select Brent Walker Orrin Bowen Jim Jensen Jerry Fannon Bill Craddock

  • Brent Walker
  • Orrin Bowen
  • Jim Jensen
  • Jerry Fannon
  • Bill Craddock
• Location
  Address

• 1. Current Registration and Insurance Card

  Yes

  No

• 2. Valid KSI Trailer Backing Card ?

  Yes

  No

• 3. Valid KSI Load Securement Card ? (Pipe Dolly Only)

  Yes

  No

  N/A

• 4. Is Trailer Hitched Up Correctly ?

  Yes

  No

  N/A

• 5. Is the Electrical Plug in Good Shape ?

  Yes

  No

• 6. Is the Break Away Cable in Good Shape ?

  Yes

  No

  N/A

• 7. Are there 2 Safety Chains ? (Good Condition)

  Yes

  No

• 8. Are the Safety Chains Crossed ?

  Yes

  No

  N/A

• 9. Are there Chalks and Cones available for the Trailer ?

  Yes

  No

• 10. Tires and Wheels in Good Shape ?

  Yes

  No

• 11. Are the Brakes Working ?

  Yes

  No

  N/A

• 12. Any Frame or Structural Damage ? (Cracked Welds or Broken Bolts)

  No

  Yes

• 13. Any Spring Damage ?

  No

  Yes

• 14. Are Hub Seals Leaking or have free play ?

  No

  Yes

• 15. Has the Bolster and Pin Been Inspected ?

  Yes

  No

  N/A

• 15.1 Does bolster rotate feely ?

  Yes

  No

  N/A

• 16. All Controls Working Smoothly and Properly ?

  Yes

  No

  N/A

• 17. All Necessary Hoses and Fittings Present ?

  Yes

  No

  N/A

• 18. Any Major Water Leaks ?

  No

  Yes

  N/A

• 19. Pump in Good Working Order ?

  Yes

  No

  N/A

• 20. Hoses and Fittings In Proper Working Order ?

  Yes

  No

  N/A

• 21. Is This Equipment In Good Working Order ?

  Yes

  No

• 22. Does This Equipment Look Clean and Well Cared For ?

  Yes

  No

• Photo of preshift if there are repairs or if not filled out correctly

  Media

Employee Information

• EE #

• Add signature

  Sign