Daily Inspection
Operator Details
Please complete all fields thoroughly and accurately. Upon completion of this report, you will receive a copy of your responses via email. Retain this email for your records.
Name
*
First Name
Last Name
Email
*
example@example.com
Today's Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Equipment Number
*
Odometer/Hours
*
Mine/Location
*
Back
Next
Daily Equipment Inspection
For any items marked "Bad," identify and comment in the provided box following this section.
Vehicle Condition
*
Rows
Good
Bad
N/A
Brakes
1
2
3
Parking Brakes
4
5
6
Back Up Alarm
7
8
9
Horn
10
11
12
Steering Components
13
14
15
Windshield Wipers
16
17
18
Windshield/Cab Glass
19
20
21
Tires
22
23
24
Fire Extinguisher
25
26
27
Seat Belt
28
29
30
Oil/Water Levels
31
32
33
Transmission Levels
34
35
36
Battery Levels
37
38
39
Brake Fluid Levels
40
41
42
Hydraulic Levels
43
44
45
Air Hose Connections
46
47
48
Brake Lights
49
50
51
Head Lights
52
53
54
Tail Lights
55
56
57
Turn Signals
58
59
60
4-Way Flashers
61
62
63
Beacon Lights
64
65
66
Heater/Defroster/AC
67
68
69
Oil Leaks
70
71
72
Transmission Leaks
73
74
75
Brake Fluid Leaks
76
77
78
Power Steering Leaks
79
80
81
Radiator Leaks
82
83
84
Hydraulic Leaks
85
86
87
Fan Belts
88
89
90
HAZARD Warning Decals
91
92
93
First Aid Kit
94
95
96
You indicated "Bad," under "Vehicle Condition." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Components/Chassis/Other Condition
*
Rows
Good
Bad
N/A
Tracks
97
98
99
Bucket & Teeth
100
101
102
Center Pin
103
104
105
Cylinder Pins
106
107
108
Cylinders
109
110
111
Housekeeping
112
113
114
Bucket Pins
115
116
117
Belts
118
119
120
Steps, Stairs, Ladders, Rails
121
122
123
Guards: Rollers, Conveyors
124
125
126
Controls & Labels
127
128
129
Cab
130
131
132
Door Hinges & Latches
133
134
135
Tool Box Doors
136
137
138
Bed
139
140
141
Grill
142
143
144
Hood
145
146
147
Fenders
148
149
150
Mirrors
151
152
153
Bumpers
154
155
156
Lift Gate
157
158
159
Emergency Stops, Guards, LOTO
160
161
162
You indicated "Bad," under "Components/Chassis/Other Condition." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Training Records
*
Good
Bad
You indicated "Bad," under "Training Records." Please explain below.
All problems shall be reported immediately to the supervisor. The discovery of unreported problems by a periodic audit may result in disciplinary consequences.
*
I understand and acknowledge I will comply with this requirement.
Back
Next
Work Place Exam and Ground Inspection
For any items marked "Bad," identify and comment in the provided box following this section.
Work Place Exam
*
Rows
Good
Bad
N/A
Roadways, Ramps, Potholes
163
164
165
Electrical
166
167
168
Flammables
169
170
171
House Keeping
172
173
174
Equipment
175
176
177
Water
178
179
180
Power Lines
181
182
183
Loading Site Controls
184
185
186
Noise & Dust Control
187
188
189
Traffic Control/Signals
190
191
192
You indicated "Bad," under "Work Place Exam." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Ground Inspection
*
Rows
Good
Bad
N/A
Water
193
194
195
Cracks
196
197
198
Holes
199
200
201
Unstable Rocks
202
203
204
Soft Ground
205
206
207
Sloped Ground
208
209
210
Highwall Hazards, Fail Protection
211
212
213
Berm Placement, Height
214
215
216
Uneven Ground
217
218
219
You indicated "Bad," under "Work Place Exam." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Signature
By signing below, I acknowledge the following: I completed this inspection on the date marked in this report. I did not falsify or omit any information relevant to this report. All inspections were physically checked and verified by me before marking each answer.
*
Submit
Should be Empty: