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Powered Mobile Equipment Checklist
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Operator Name
*
Operator Email
*
example@example.com
Company
Work Site
*
RW-541 Sunridge Mall Snow Removal
RW-705 Bridgeland Improvements Project
RW-752 Carstairs Hwy 2A Improvements
RW-760 15th Avenue Mobility Improvements
RW-764 Sunnyside Flood Barrier 2025/26
RW-768 Saddlebrook Pavement Rehab
RW-771 CFD Apparatus Slab Replacement
RW-773 14th Street NW Pathway
RW-774 18th St SE Pathway
RW-778 Bow View Manor Emergency Work
UG-728 Mandalay Phase 5B
UG-730 NWIC Phase 2 (Kensington)
UG-743 Lawrey Gardens Outfall B76
UG-747 Cochrane Emergency Repairs
UG 754 - Water maintenance RFSO
UG-759 - Fish Creek Sludge Forcemain Upgrades
UG-761 Bow River Siphon Line Stop & Isolation Valve
UG-765 52 St and Memorial Dr. NE Feedermain
UG-766 2025 Watermain Replacement
UG-777B BPSFM Emergency Inspection Support
UG-777C Pipe Diver Installation
UG-779 Phase 4 Bearspaw Feedermain Repairs
UG-784 Shepard Energy Centre-Repair SOR
UG-785 Discovery Ridge Lift Station
UG-786 Bowness Park Cross Tie
CP-676 CP Rail Work
36 Avenue Yard
Balzac Shop
Spring Garden Lay Down
Enter Work Site Name if not listed above
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of
Equipment
*
Dozer
Excavator
Grader
Loader
Packer/Compactor
Paver
Rock Truck
Roller
Skidsteer
Other
Unit #
*
Current Hour Meter
Next Service Due at
hours
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
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
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.
Are locates distributed: Yes: Ticket # , expiry date?
Do locates cover excavation area?
Have utility markers been maintained?
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 dual 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
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
Is this machine safe and acceptable for operation?
*
YES
NO
Does this machine require maintenance?
*
YES
NO
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