Gas Concrete Buggy Pre-Use Inspection Checklist
Operator
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
TCF
*
Floors
Forming
Project Name
*
1147 - 33 Dundas
1163 - Terminal 1
1180 - Stone Road Mall
1187 - Live Nation
1190 - Mt Sinai - Grinding
1194 - YMCA Vaughan
1195 - Guess - Eaton Centre
1198 - Apple - Fairview
1203 - Fire Hall
1206 - Sears - Fairview Mall
1207 - Film School
1210 - Seneca
17013 - Cooksville
17014 - Wellesley
18001 - Mt Sinai
18002 - Kipling
19003 - Fire Hall
Other
If Other
Location at Job Site
*
Email
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Make and Model of Concrete Buggy
*
Whiteman WBH-16EF
Other
Other
Buggy Serial Number
*
Ground Type
*
Asphalt
Concrete
Dirt
Grass
Gravel
Ground Conditions
*
Dry
Ice
Mud
Snow
Wet
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Operator has reviewed Concrete Buggy Manual
*
CO Detector and Log Book Available
*
Route Examined for Hazards
*
Fluids Leaking
*
Fluid Levels OK
*
Tires OK
*
Brakes Functional
*
Steering Functional
*
Dumping Mechanism Functional
*
Spotter Needed
*
Visual Inspection
*
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Comments
Signature of Operator
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Should be Empty: