Powered Mobile Equipment Checklist
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Operator Name
*
Brian Williams
Christopher McKenzie
Clinton Whelan
Linda Lemery
Lisle Edmunds
Logan Whelan
Max Gath
Oliver Nutt
Robert Massie
Trevor Soltys
Will Hickey
Andrea Dupont
Other
Operator Email
*
example@example.com
Equipment
Dozer: D5
Excavator: CASE CX210B
Excavator: CAT 323F
Excavator: John Deere 210G
Grinder/Screener: Doppstadt
Grinder/Screener: Finlay 1060
Grinder/Screener: Trommel
Grinder/Screener: Tubgrinder
Grinder/Screener: Turbo Chieftain 1400
Other: Bobcat T450
Other: Ford LTL9000
Other: Hydrema 922D Rock Truck
Other: Water Truck GMC7500
Track Loader: CAT 973C
Track Loader: CAT 973K
Vehicle: Dodge Ram 1500 "Betty White"
Vehicle: Dodge Ram 1500 "Black Betty"
Vehicle: Ford Lightning
Vehicle: Service Truck Power Ram
Wheeled Loader: CASE 821F "Stinky"
Wheeled Loader: Hitachi ZW220 Lime
Wheeled Loader: Hitachi ZW220 NEW
Other
Current Hour Meter
Mileage
Fuel Added?
*
Yes
No
Gallons of Fuel Added
Outside
*
Rows
N/A
Satisfactory
Repair Required
Lights
Steps/Hand Rails
Tires/Tracks
Exhaust
Fenders
Buckets
Cutting Edge/Teeth
Lifting Mechanism
Hoses
Fittings Greased
Hitch/Coupler
Wipers
1. Pre-Start (Walk-Around) Inspection
*
Rows
Pass / Fail
Notes
Are the operators, safety and responsibilities manuals available?
Pass
Fail
Tire condition (if applicable) and pressure, rim condition, lug nuts tight
Pass
Fail
Boom/Mast condition, pins and retainers, welds, damaged attachments
Pass
Fail
Fuel, oil, hydraulic oil, antifreeze and battery charge levels, daily grease
Pass
Fail
Cab or platform cleanliness, dents or scratches, decals and placards
Pass
Fail
Signs of fluid leaks on engine, hydraulic cylinders, hoses or ground
Pass
Fail
Seat belt, personal harness, lanyard, anchorage points, gates and safety chains
Pass
Fail
Glass, seat, mirrors, doors, compartment covers
Pass
Fail
Comments/Notes
2. Equipment Running Tests
*
Rows
Pass / Fail
Notes
Ground and platform controls, emergency systems, operate all functions
Pass
Fail
All hydraulic systems and their respective functions
Pass
Fail
Brakes, steering, lights, horn, warning beepers and lights
Pass
Fail
Comments/Notes
3. Job Site Work Area Inspection
*
Rows
Completed?
Notes
Walk the intended work route, remove hazards and obstructions
Observe ground conditions, pot holes, culverts, soft or unstable zones etc.
Observe weather conditions, wind, rain, snow, ice etc.
Look for power lines, overhead obstructions, personnel and vehicle zones etc.
Comments/Notes
4. Safe Machine Operation
*
Rows
Yes / No
Notes (If NO provide Details Here)
Have I read and understood the responsibilities, safety and operators manuals?
Yes
No
Have I received authorization to operate this machine?
Yes
No
Do I practice 360 degree awareness when operating?
Yes
No
Do I have qualified personnel on site who can help in an emergency situation?
Yes
No
Do I have a functioning communication system at hand?
Yes
No
Comments/Notes
5. Safe Machine Shut Down and Security
*
Rows
Yes / No
Notes (If NO provide Details Here)
Do I have a safe place to park the machine and secure keys at end of shift
Yes
No
Are lock-out tags available on machine if required?
Yes
No
Comments/Notes
Is this machine safe and acceptable for operation?
*
YES
NO
Does this machine require maintenance?
*
YES
NO
Take a Picture
Upload image
Cancel
of
Comments:
Signature
*
Submit
Should be Empty: