Clone of Heavy Equipment Pre Trip Inspection

Check Date* This field is required.

Date

Operator Name* This field is required.

First Name

Last Name

Equipment ID / Unit Number* This field is required.

Equipment Type* This field is required.

Engine Oil Level* This field is required.

Full

Low

Filled

Needs Attention

Engine Oil Level Notes

How much fluid was added?

Hydraulic Fluid Level* This field is required.

Full

Low

Filled

Needs Attention

Hydraulic Fluid Level Notes

How much fluid was added?

Coolant Level* This field is required.

Full

Low

Filled

Needs Attention

Coolant Level Notes

How much fluid was added?

Fuel Level* This field is required.

Full

Low

Filled

Needs Attention

All Grease Points Greased?

Yes

How much fluid was added?

Fluids / Hydraulics Notes

Service Brakes* This field is required.

Pass

Needs Attention

Fail

Not Applicable

Service Brakes Notes

Parking Brake* This field is required.

Pass

Needs Attention

Fail

Not Applicable

Parking Brake Notes

Tracks or Tires Condition* This field is required.

Pass

Needs Attention

Fail

Tracks or Tires Condition Notes

Undercarriage Condition* This field is required.

Pass

Needs Attention

Fail

Undercarriage Condition Notes

Brakes / Undercarriage Notes

Headlights* This field is required.

Pass

Needs Attention

Fail

Work Lights* This field is required.

Pass

Needs Attention

Fail

Work Lights Notes

Operator Controls* This field is required.

Pass

Needs Attention

Fail

Operator Controls Notes

Mirrors / Visibility Aids* This field is required.

Pass

Needs Attention

Fail

Mirrors / Visibility Aids Notes

Lighting / Controls Notes

Engine Performance* This field is required.

Pass

Needs Attention

Fail

Engine Performance Notes

Transmission / Driveline* This field is required.

Pass

Needs Attention

Fail

Transmission / Driveline Notes

Frame and Structural Integrity* This field is required.

Pass

Needs Attention

Fail

Frame and Structural Integrity Notes

Hydraulic Lines* This field is required.

Pass

Needs Attention

Fail

Hydraulic Lines Notes

Rams* This field is required.

Pass

Needs Attention

Fail

Pins, Couplings, and Attachment Points* This field is required.

Pass

Needs Attention

Fail

Pins, Couplings, and Attachment Points Notes

Engine / Frame Notes

Fire Extinguisher* This field is required.

Extinguishers Present

Nozzle Condition OK

Pressure Gauges OK

Safety Pins Secured

Extinguisher Securly Mounted

Minimum 2A10BC Rating

Other

Fire Extinguisher Expiration Date

Date

Firefighting Tools & Accessories* This field is required.

Shovel

Pulaski

Axe

2.5 Gallon Water Extinguisher

Other

CAL FIRE Required PPE for Hired Vendors* This field is required.

One (1) NFPA 1977 approved wildland helmet

One (1) NFPA 1977 approved Nomex or Sigma hood or shroud

One (1) pair NFPA 1977 approved eye protection

One (1) pair NFPA 1977 approved protective gloves

One (1) pair NFPA 1977 approved boots

One (1) NFPA 1977 approved Nomex or Sigma shirt

One (1) pair NFPA 1977 approved Nomex or Sigma pants

One (1) USFS approved fire shelter (FS 5100-606)

One (1) flashlight (for night operations)

Drinking water (one quart per person, per hour)

One (1) radio with specifications as per form HE-100R and confirmation of proper operation and programming prior to incident arrival

Other

Safety Gear Checks* This field is required.

PPE Present

OSHA 5 Person Minimum First Aid Kit Present

Fire Curtains Securly Mounted

Flashlight

Mobile Radio Functioning

Other

Fire Gear / Accessory Notes

Equipment with Water On Board* This field is required.

Yes

Operational Equipment Checks* This field is required.

Pump Operational

Water Tank Full

Water Tank No Leaks

Hose Reel Operational

Emergency Shutdown Works

Warning Alarm Works

Other

Equipment Checks

Nozzle, combo fog/straight stream, 1” NPSH Female

Double Male, 1” NPSH

Double Female, 1” NPSH

Reducer, 1 ½” NH Female to 1” NPSH Male

Reducer, 1” NPSH Female to ¾” Garden Hose Male

Adapter, 1” NH Female to 1” NPSH Male

Adapter, 1” NPSH Female to 1” NH Male

Spanner Wrench, combination 1” & 1 ½”

Fire Hose Clamp, Forestry

Hose – 200’

20’ Suction hose with strainer or screened foot valve

Other

Equipment with Water On Board Notes

Maintenance / Repair Notes