Daily Inspection
Personnel 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
*
Please Select
Ball, Gordon
Haddock, Paul
Isaacs, Joe
Johnson, Matthew
Littrell, Johnny
Naese, Josh
Priest, Jeff
Ray, Brandon
Sadler, Jonathan
Teutemacher, Jason
Other
Email
*
example@example.com
Name
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Equipment Being Inspected
*
Please Select
CAT 950K
JD 180G
JD 200
JD 300G #1065
JD 300G #0673
JD 290
JD 844 #1215
JD 844 #0971
Kobelco 250
Komatsu 170LC-11
Komatsu PC400LC
MGL EX1
Sandvik QE341
Sandvik QJ341
Terex TA40
Other
# = Serial No. last 4 digits.
Other Equipment
Odometer/Hours
*
Mine/Location
*
Please Select
Argos Cement Plant
Cemex Brooksville Quarry
Cemex Center Hill Quarry
Cemex Inglis Quarry
Cemex St. Catherine Quarry
Central State Aggregates
CYD Jacksonville
CYD Wildwood
Holcim CR Quarry
LaBelle
Lhoist Lowell Mine
Midcoast Aggregates
MM Perry Quarry
MM Soutel
SCI Materials Quarry
Other
Other Location
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Daily Equipment Inspection
For any items marked "Bad," identify and comment in the provided box following this section.
Screener/Scalper/Crusher Condition
*
Good
Bad
N/A
Tires
1
2
3
Fire Extinguisher
4
5
6
Oil/Water Levels
7
8
9
Battery Levels
10
11
12
Hydraulic Levels
13
14
15
Beacon Lights
16
17
18
Oil Leaks
19
20
21
Radiator Leaks
22
23
24
Hydraulic Leaks
25
26
27
Fan Belts
28
29
30
HAZARD Warning Decals
31
32
33
First Aid Kit
34
35
36
You indicated "Bad," under "Screener/Scalper/Crusher Condition." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
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of
Components/Chassis/Other Condition
*
Good
Bad
N/A
Tracks
37
38
39
Jaws
40
41
42
Steps, Stairs, Ladders, Rails
43
44
45
Guards: Rollers, Conveyors
46
47
48
Controls & Labels
49
50
51
Belts
52
53
54
Emergency Stops, Guards, LOTO
55
56
57
You indicated "Bad," under "Components/Chassis/Other Condition." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
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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.
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Daily Equipment Inspection
For any items marked "Bad," identify and comment in the provided box following this section.
Equipment Condition
*
Good
Bad
N/A
Brakes
58
59
60
Parking Brakes
61
62
63
Back Up Alarm
64
65
66
Horn
67
68
69
Steering Components
70
71
72
Windshield Wipers
73
74
75
Windshield/Cab Glass
76
77
78
Tires
79
80
81
Fire Extinguisher
82
83
84
Seat Belt
85
86
87
Oil/Water Levels
88
89
90
Transmission Levels
91
92
93
Battery Levels
94
95
96
Brake Fluid Levels
97
98
99
Hydraulic Levels
100
101
102
Air Hose Connections
103
104
105
Brake Lights
106
107
108
Head Lights
109
110
111
Tail Lights
112
113
114
Turn Signals
115
116
117
4-Way Flashers
118
119
120
Beacon Lights
121
122
123
Heater/Defroster/AC
124
125
126
Oil Leaks
127
128
129
Transmission Leaks
130
131
132
Brake Fluid Leaks
133
134
135
Power Steering Leaks
136
137
138
Radiator Leaks
139
140
141
Hydraulic Leaks
142
143
144
Fan Belts
145
146
147
HAZARD Warning Decals
148
149
150
First Aid Kit
151
152
153
You indicated "Bad," under "Vehicle Condition." Please identify and comment below.
Attach any relevant photos of items marked "Bad" below.
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Components/Chassis/Other Condition
*
Good
Bad
N/A
Tracks
154
155
156
Bucket & Teeth
157
158
159
Center Pin
160
161
162
Cylinder Pins
163
164
165
Cylinders
166
167
168
Housekeeping
169
170
171
Bucket Pins
172
173
174
Belts
175
176
177
Steps, Stairs, Ladders, Rails
178
179
180
Guards: Rollers, Conveyors
181
182
183
Controls & Labels
184
185
186
Cab
187
188
189
Door Hinges & Latches
190
191
192
Tool Box Doors
193
194
195
Bed
196
197
198
Grill
199
200
201
Hood
202
203
204
Fenders
205
206
207
Mirrors
208
209
210
Bumpers
211
212
213
Lift Gate
214
215
216
Emergency Stops, Guards, LOTO
217
218
219
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.
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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
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