PB Heavy Equipment Track Inspection Report

Database No.: Contractor: Area:

Reg. No: Date:
Fleet No: Inspection by:
Equipment Type: (Underline or Circle) Compliance = 1 * Non-compliance = 0
Bulldozer, Track Excavator, Sheep foot Not Applicable = N/A
Compactor, Smooth Drum Compactor,
Amphibious Excavator, Track Loader
CPI HES Guideline Vol. III OS. 29
Item DESCRIPTION Score REMARKS
A STANDARD SAFETY DEVICES
01 Safety Belt / Seat Operator
- Seat belt lock mechanism working
02. View Mirrors (Sides & Rear)
- The mirror in good condition and/or damage to
obstruct views
03 Horn
Ensure the horn in working order and sound in
strong enough
04 Back Up Alarm (Exception for 360 degree
equipment)
Ensure that alarm working properly and sound
good strong enough
05 Service Brakes & Parking Brake
Ensure those equipment in working order and ask
the operator for well function
TOTAL SCORE Total Possible- 5 - _____N/A = _____
B LIMITED USE
01 Winch Cable
Ensure the winch in working order and the
cable/sling rigged as per rigging practices
02 Amber Beacon
Ensure that is safety devices is in working order
03 Hour Meter
Ensure those safety devices are in working order
04 Expired CPI Permit / SIO / Govt. License
Ensure those permit in valid condition
05 Safety Belt / Seat Passenger
- Seats for all vehicles all passenger
TOTAL SCORE Total Possible- 5 - _____N/A = _____
C MECHANICAL / NEED ASSISTANCE
01 Oil Engine / Transmission / hydraulic Oil
Check the condition from leakages or any other
defective
02 Water Radiator / Driver Belt / Battery Levels,
Terminal
Check the function in working order
03 Gear Oil / Fuel Diesel
Check the condition & function
04 Steering / Brake / Gear Lock
Check those equipment in working order
05 Air Gauge / Oil / Temperature Gauge
Ensure that is in well function and working order
06 Track Shoes / Bolts / Connection Link
Ensure that is in well function and working order
07 Sprocket / Idler / Rollers
Check the condition in working order
08 Body / Engine Hood
Check the body and cabin house keeping and
engine hood condition
09 Others
Notes on this section for other non-compliances
were not shown on above description
TOTAL SCORE Total Possible- 9 - _____N/A = _____

SCORING SUMMARY
Section Total i.
Section Total B. Total Possible:
Section Total C. Total Possible:
TOTAL SCORE Total Score Possible:

FINAL RATING: TOTAL SCORE X 100 = __________ %

Total Score Possible

*NOTE: Record Non - Compliance items on Inspection Summary Report.

Remarks
Attendees:_____________________________________________________________________________________________

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