Water Support Vehicle

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vehicle Information

• Photo of Water Vehicle

  Media

• Operator

• Contractor & Unit #

• Make/Model

Safety Equipment

• Fire Extinguisher

  Yes

  No

  N/A

• First Aid Kit (type)

  Yes

  No

  N/A

• Escape Hatch? What kind and where is it on the machine?

  Safe

  At Risk

  N/A

• Seat Belts

  Safe

  At Risk

  N/A

• Two Way Radio, handheld or mounted? Does it have the necessary channels programmed?

  Working Order

  Out of Order

  N/A

• GPS

  Working Order

  Out of Order

  N/A

• Tire Chains

  Yes

  No

  N/A

• Backup Alarm

  Working Order

  Out of Order

  N/A

• Placards

  Yes

  No

  N/A

• Tool Kit

  Yes

  No

  N/A

• Spill Kit

  Yes

  No

  N/A

Mechanical

• Fluid Leaks

  Yes

  No

  N/A

• Brakes

  Working Order

  Out of Order

  N/A

• Parking Brake

  Working Order

  Out of Order

  N/A

Lights/Electrical

• Headlights

  Working Order

  Out of Order

  N/A

• Work Lights and Signal

  Working Order

  Out of Order

  N/A

• Beacon

  Working Order

  Out of Order

  N/A

• Turning Signals

  Yes

  No

  N/A

• Brake Lights

  Yes

  No

  N/A

• Rear Lights

  Yes

  No

  N/A

Visibility

• Mirrors

  Safe

  At Risk

  N/A

• Windshield (cracks/chips)

  Safe

  At Risk

  N/A

• Side Screen or Glass

  Safe

  At Risk

  N/A

Winches

• Winch Condition

  Working Order

  Out of Order

  N/A

• Winch Cable (frays/kinks)

  Safe

  At Risk

  N/A

• Cable Clamps, type.

  Safe

  At Risk

  N/A

Miscellaneous

• Outside Appearance

  Safe

  At Risk

  N/A

• Engine Cleanliness

  Safe

  At Risk

  N/A

• Wheel/Track Condition

  Safe

  At Risk

  N/A

• No Loose Items in Cab

  Yes

  No

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Tow Hooks

  Safe

  At Risk

  N/A

• Hose Fittings

  Safe

  At Risk

  N/A

• Water Tank

  Safe

  At Risk

  N/A

• Propane

  Yes

  No

  N/A

PPE

• Hard Hat

  Yes

  No

  N/A

• High Visibility Vest/Clothing

  Yes

  No

  N/A

• Safety Boots

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Notes

• Items Needing Repair

• Auditor

  Sign