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PRE-USE INSPECTION

USE PDF PRE-USE INSPECTION FORM

VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST

GENERAL EQUIPMENT INFORMATION

Please enter INCIDENT NAME/NO
Please enter RESOURCE ORDER NO
Please enter CONTRACTOR NAME
Please enter AGREEMENT NO
Please enter EXPIRATION DATE
Please enter MAKE/MODEL
Please enter VIN/SERIAL NO
Please enter EQUIPMENT TYPE
Please enter . LICENSE NO./STATE

PRE-USE INSPECTION

Please check ACCEPTED OR REJECTED
Enter starting mileage
Please enter DATE OF INSPECTION
Enter time of inspection
Enter inspector's name

Inspector's Signature

Enter title of inspector
Inspector's Signature Upload
Field is required!

LIABILITY

The purpose of this checklist is to document pre-existing vehicle/equipment condition and to determine suitability for incident use. I hereby acknowledge full responsibility and liability for the operation and mechanical condition of the vehicle/ equipment described herein.

Operator's name & title

Operator's Uploaded signature & date

Please enter OPERATOR'S NAME
SIGNATURE:
Field is required!
Please enter OPERATOR'S TITLE
Please enter TODAY'S DATE

TRANSPORT OF SUPPORT VEHICLES

1. DOT'' or CVSA inspection in the last 12 months (if required).

Please sleect YES OR NO OR N/A DOT Inspection

2. Gauges and lights: mounted and function properly.

Please select YES OR NO OR N/A GAUAGES & LIGHTS

3. Seat belts: operate properly for each seating position.

Please select YES OR NO OR N/A SEAT BELTS OPERATION

4. Glass and mirrors, no cracks in vision

Please select YES OR NO OR N/A GLASS & MIRRIERS OPERATION

5. Wipers, washers, and horn operate properly.

Please select YES OR NO OR N/A WIPERS, WASHERS & HORN OPERATION

6. Clutch pedal: proper adjustment (if applicable).

Please select YES OR NO OR N/A CLUTCH OPERATION

7. Cooling system: full, free of leaks and damage

Please select YES OR NO OR N/A COOLING SYSTEM FULL, FREE OF LEAKS & DAMAG

8. Fluid levels (e.g. oil) and condition: full and clean.

Please select YES OR NO OR N/A FLUID LEVELS FULL & CLEAN

9. Battery: check for corrosion, loose terminals and hold downs.

Please select YES OR NO OR N/A BATTERY CORROSION-LOOSE TERMINALS

10. Fuel system: free of leaks and damage.

Please select YES OR NO OR N/A FUEL SYSTEM FREE OF LEAKS DAMAGE

11. Electrical system: alternator and starter work.

Please select YES OR NO OR N/A ELECTRICAL SYSTEM ALTERNATOR & STARTER WORK

12. Engine running: check oil pressure. knocks, and leaks

Please select YES OR NO OR N/A ENGINE RUNNING OIL KNOCKS LEAKS

13. Transmission: check for leaks

Please select YES OR NO OR N/A TRANSMISSION CHECK FOR LEAKS

14. Steering components: tight, free of play.

Please select YES OR NO OR N/A STEERING TIGHT FREE OF PLAY

15. Brakes: damaged, worn or out of adjustment.

Please select YES OR NO OR N/A BRAKES DAMAGED WORN OUT ADJUSTMENT

16. Exhaust system: no leaks under cab or before turbo.

Please select YES OR NO OR N/A EXHAUST NO LEAKS

17. Frame condition, body/bed properly attached.

Please select YES OR NO OR N/A FRAME CONDITION PROPERLY ATTACHED

18. Tires/wheels (including spare and all changing equipment)

Please select YES OR NO OR N/A TIRES SPARE CHANGING EQUIPMENT

19. Body and interior condition: describe and locate damage

Please select YES OR NO OR N/A BODY & INTERIOR ANY DAMAGE

20. Emergency equipment required. | Fire extinguisher, Spare fuses, Reflectors

Please select YES OR NO OR N/A EMERGENCY EQUIPMENT IS PRESENT

Operator(s) properly licensed.

Enter LICENSE EXPIRATION DATE
Enter DRIVER LICENSE NUMBER
Enter DRIVER LICENSE ENDORSEMENT
  • STATE DRIVER LICENSE EXPIRE
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Enter STATE DRIVER LICENSE EXPIRE
Enter CLASS OF DRIVER LICENSE
Enter MEDICAL CERTIFICATE EXPIRATION

RELEASE

Enter TIME OF RELEASE
Enter INSPECTOR'S NAME OF RELEASE
Enter INSPECTOR'S NAME OF RELEASE TITLE
Enter MILES/HOURS:
Enter OPERATOR'S NAME
NO DAMAGE/NO CLAIM
YES (NO DAMAGE/CLAIM) NO (THERE IS DAMAGE/CLAIM)
Enter DATE OF RELEASE
Enter OPERATOR'S TITLE

REMARKS

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