Pre-trip Inspection Form
Vehicles or Heavy//Mobile Equipment
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*
Enter Passcode (Coast9401) to unlock form.
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Enter your Employee Number
If you have no employee number select the option below
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Form Section
First Name
*
Employee Name
Last Name
*
Email
example@example.com
Supervisor
Additional Reporting Manager
Michael Beaumont
Brianna Belzile
Don Coles
Brett Friesen
Maico Furtado
Mike Hannam
Bradley MacDonald
Doug Marshall
Kevin Martyn
Brad McDonald
Bruce Stauffer
Darien Stead
Daniel Tack
Jack Vanderbasch
Juergen Wasner
Dennis Whitten
Select additional reporting manager if required.
Report Copy Emailed To:
Safety Sync
Michael Beaumont
Brianna Belzile
Don Coles
Brett Friesen
Maico Furtado
Mike Hannam
Bradley MacDonald
Doug Marshall
Kevin Martyn
Brad McDonald
Bruce Stauffer
Darien Stead
Daniel Tack
Jack Vanderbasch
Juergen Wasner
Dennis Whitten
Location
*
Chemainus - Compost
Chemainus - Industrial Waste & Remediation
Chemainus - Operations
Chemainus - Portables & Fencing
Chemainus - Wastewater
Courtenay - Industrial Waste & Remediation
Courtenay - Operations
Courtenay - Portables & Fencing
Courtenay - Wastewater
Duncan - Industrial Waste & Remediation
Nanaimo - Industrial Waste & Remediation
Nanaimo - Operations
Nanaimo - Portables & Fencing
Nanaimo - Wastewater
Victoria - Highwest
Victoria - Operations
Victoria - Portables & Fencing
Victoria - Service & Installs
Victoria - SPL
Victoria - Wastewater
Location Address
Date
*
-
Month
-
Day
Year
Date
Hour/Odometer Meter
Inspection 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
Equipment Type
*
Vehicle and Tractors
Heavy Equipment
Choose one of the three types
EquipID
*
Enter your three digit unit number (ex: 001, 010, 100)
Vehicle and Trailers Questions
Truck Plate or Unit #
Items Inspected - Truck
Ok
Needs Repair
N/A
Comments
Air Brake System
Cab
Cargo Securement
Coupling Devices
Dangerous Goods (If Any)
Driver Controls
Driver Seat
Electric Brake System
Emergency Safety Equip/ Safety Devices
Exhaust System
FFrame and Cargo Body
Fuel System
General Defects
Glass and Mirrors
Heater Defroster
Horns
Hydraulic Brake System
Lamps and Reflectors
Steering
Suspension System
Lamps and Reflectors
Steering
Suspension System
Tires
Wheels/ Hubs/ Fasteners
Windsheild Wipers & Washers
Above Defects Corrected?
Yes
No
Above defects need to be corrected for safe operation of vehicle?
Yes
No
Trailer Unit #
Items Inspected - Trailer
Ok
Needs Repair
N/A
Comments
Air Brake System
Cab
Cargo Securement
Coupling Devices
Dangerous Goods (If Any)
Driver Controls
Driver Seat
Electric Brake System
Emergency Safety Equip/ Safety Devices
Exhaust System
FFrame and Cargo Body
Fuel System
General Defects
Glass and Mirrors
Heater Defroster
Horns
Hydraulic Brake System
Lamps and Reflectors
Steering
Suspension System
Lamps and Reflectors
Steering
Suspension System
Tires
Wheels/ Hubs/ Fasteners
Windsheild Wipers & Washers
Heavy Equipment Questions
Heavy/Mobile Equipment Checks
OK
Needs Repair
N/A
Comments
Engine Oil Level
Radiator Water Level/ Makeup Tank
Fuel Level
Obvious Damage and Leaks
Tire/ Track Conditions
Head and Tail Lights
Warning Lights
Hour Meter
Other Gauges and Instruments
Seat Belt Condition
Operational Checks
OK
Needs Repair
N/A
Comments
Horn
Steering
Service Brakes
Parking Brake
Hydraulic Controls
Comments and Signature
Comments:
Operators signature
*
Submit
FORM ID
FORM TITLE
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