Fiber Equipment Inspections

Fiber Equip - Safety Inspection 2.0 (137)

Inspection Date(Required)

Inspector's Name(Required)

Equipment Site(Required)

ONW

XSM

Equipment Inspection Template(Required)

Equipment Inspected

Directional Drills(Required)

(#D1) DW JT520 Directional Drill - CMWJT520C7000015

(#D2) DW JT922 Directional Drill (2009) - CMWJT922V90000334

(#D4) DW JT520 Directional Drill - CMWJT520A70000100

(#D5) DW JT5 Directional Drill - DWPJT5XXEM0000647

Other

Pumps(Required)

(#D1) Mounted Pump

(#D2) Mounted Pump

(#D4) 2018 Predator Pump

NONE - No Mounted Pump

Other

Select "Other" and type None - IF no Mounted Pump is present on a Combo Unit Inspection.

Mix Systems(Required)

(#D1) DW/FT5 Mix System - DWPFT5XXPH0000339

(#D2) DW/FMS Mix System - CMWFM5XXL900000739

(#D4) DW/FM5 Mix System - CMWFM5XXT60000077

NONE - No Mounted Mix System

Other

Select "Other" and type None - IF no Mounted Mix System is present on a Combo Unit Inspection.

VACs(Required)

VAC HX30 - DWPHX30XVL000082

VAC HX50 - DWPHX50XKL0000236

VAC FX60 - CMWFX60XHA0000415

VAC FX60 - CMWFX60XHA0000025

Other

Trailers(Required)

Plow(Required)

Ditch Witch 100SX (sm) - 4X0226

Ditch Witch 410SX (lg) - 4T1215

Other

Excavator(Required)

Mini Excavator - Cat303.5ECR

Other

Forklift(Required)

Hyster Forklift (2005 60XM) - H177B56334C

Other

Generator(Required)

MultiQuip 45KW generator Model # DCA45SSIUII Serial # 720188

Other

Directional Drill Inspection

Drill Hours(Required)

Visual: Drill Platform free from dirt.(Required)

Yes - Good Condition

⚠ No - Needs Attention

Drill Levers/Controls Operational(Required)

Yes - Good Condition / Functional

⚠ No - Needs Attention

⚠ Lever/Control Issue Description(Required)

Drill Warning Lights & Devices Functional(Required)

Yes - Good Condition / Functional

⚠ No - Needs Attention

⚠ Drill Warning Light / Device Issue Description(Required)

Drill Frame Condition(Required)

Yes - Good Condition / Functional

⚠ No - Damaged or Bent

⚠ Drill Frame Condition Description(Required)

Drill Rods Condition(Required)

Present & In Good Condition

⚠ No - Damaged /Bent/Broken/Missing

⚠ Drill Rod Issue Description(Required)

Drill Beacon Housing Condition(Required)

Present / Functioning / In Good Condition

⚠ No - Damaged /Bent/Broken/Missing

⚠ Drill Beacon Housing Issue Description(Required)

Drill Beacon Condition(Required)

Present / Functioning / In Good Condition

⚠ No - Damaged /Bent/Broken/Missing

⚠ Drill Beacon Issue Description(Required)

Drill Motor

Drill Motor Oil(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

⚠ Drill Motor Oil Issue Description(Required)

Drill Hydraulic Fluid(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

⚠ Drill Hydraulic Fluid Issue Description(Required)

Drill Fan Belt(Required)

Belt in Good Condition / belt is tight

Belt in Good Condition / ⚠ belt is loose

⚠ Belt in Poor Condition / belt is tight

⚠ Belt in Poor Condition / ⚠ belt is loose

⚠ Drill Fan Belt Issue Description(Required)

Drill Motor Visual Scan: Is anything out of place?(Required)

⚠ Yes - Needs attention

⚠ Drill Motor Issue Description(Required)

Drill Water System

Water System Filter Cup Condition(Required)

Yes - in Good Condition / cups are clear

Filter Cups in Good Condition / ⚠ cups dirty - need attention

⚠ Filter Cups in Poor Condition / cups are clear

⚠ Filter Cups in Poor Condition / ⚠ cups dirty - need attention

Water Filter

Filter is in Good Condition

⚠ Filter is in Poor Condition

⚠ Water Filter Issue Description(Required)

Water Hose(Required)

Hose is in Good Condition

⚠ Hose is in Poor Condition

⚠ Water Hose Issue Description(Required)

Anti-freeze (seasonal)(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

⚠ Anti-freeze Issue Description(Required)

Drill Anchor & Wench Systems

Anchor System Functional

Yes - Working and in Good Condition

⚠ Working but in Poor Condition

⚠ No - Not Working and in Good Condition

⚠ Anchor System Issue Description

Wrench System Functional

Yes - Working and in Good Condition

⚠ Working but in Poor Condition

⚠ No - Not Working and in Good Condition

⚠ Wrench System Issue Description

Pump

Mount Stability(Required)

Pump is securely mounted

⚠ Coming Loose - Needs Attention

Pump Functionality(Required)

Pump is functional

⚠ Does not function - Needs Attention

Mix System

Mix System Hours(Required)

Mount Stability(Required)

Mix System is securely mounted

⚠ Coming Loose - Needs Attention

Mix System Condition / Functionality

Yes - in Good Condition and Functional

⚠ in Poor Condition but Functional

⚠ No - Not Working

⚠ Mix System Issue Description

Hose Condition / Functionality(Required)

Yes - in Good Condition and Functional

⚠ in Poor Condition but Functional

⚠ No - Not Working

Hose Issue Description(Required)

Mix System Motor Condition / Functionality(Required)

In Good Condition and Functional

⚠ In Poor Condition but Functional

⚠ Not Working

⚠ Mix System Motor Condition Issue Description*(Required)

Starter Rope Condition / Functionality(Required)

In Good Condition and Functional

⚠ In Poor Condition but Functional

⚠ Not Working

⚠ Starter Rope Issue Description(Required)

Air Filter Condition / Functionality(Required)

In Good Condition and Functional

⚠ In Poor Condition but Functional

⚠ Not Working

Air Filter Issue Description(Required)

Mix System Motor Oil

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

⚠ Mix System Motor Oil Issue Description(Required)

Mix System Anti-freeze (seasonal)(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

⚠ Mix System Anti-freeze Issue Description(Required)

Mix System Visual Scan: Is anything out of place?(Required)

⚠ Yes - Needs attention

⚠ Mix System Anti-freeze Issue Description(Required)

Vacuum

Vac Hours(Required)

Visual Inspection: Vac free from dirt(Required)

Yes - Good Condition

⚠ No - Needs Attention

VAC Levers & Controls(Required)

Operational

⚠ not functioning correctly

⚠ VAC Levers & Controls issue description(Required)

Warning Lights & Devices(Required)

Functional

⚠ not functioning correctly

⚠ Warning Lights & Devices issue description(Required)

Left Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Right Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Right Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Left Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

VAC Filter(Required)

Yes - Good Condition

⚠ No - Needs Attention

VAC Motor Oil(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

VAC Hydraulic Fluid(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

VAC Battery condition(Required)

Good Condition

⚠ Poor Condition

VAC Belt condition(Required)

Good Condition

⚠ Poor Condition

VAC Water Tank condition(Required)

Good Condition

⚠ Poor Condition

VAC Water Tank cleanliness(Required)

Good / Clean

⚠ Poor / Dirty Condition - Needs Attention!

VAC Autoclutch condition(Required)

Good Condition

⚠ Poor Condition - Needs Attention!

Disengages if no pressure

VAC Hoses condition(Required)

Good Condition

⚠ Damaged / Poor Condition - Needs Attention

VAC Hose Reel condition(Required)

Mechanical Lock in Good Condition

⚠ Mechanical Lock in Poor Condition - Needs Attention

VAC Valve condition(Required)

Functional in Good Condition

⚠ Poor Condition - Needs Attention

VAC Water Filter condition

Good Condition

⚠ Poor Condition - Needs Attention

VAC Anti-freeze (seasonal)(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Trailer

Visual: Trailer Platform Free from Dirt(Required)

Yes - Good Condition

⚠ No - Needs Attention

Trailer Platform / Base Condition(Required)

Good / Solid Condition

⚠ No - Needs Attention

⚠ Trailer Platform Base Issue Description(Required)

Trailer Turn Signals Functional(Required)

Yes - Functional

⚠ Functional with concerns

⚠ No - Needs Attention

⚠ Trailer Turn Signal Issue Description(Required)

Trailer Tail Lights Functional(Required)

Yes - Functional

⚠ Functional with concerns

⚠ No - Needs Attention

⚠ Trailer Tail Light Issue Description

Trailer Brake Lights Functional(Required)

Yes - Functional

⚠ Functional with concerns

⚠ No - Needs Attention

⚠ Trailer Brake Light Issue Description(Required)

Trailer Brakes Functional(Required)

Yes - Functional

⚠ Functional with concerns

⚠ No - Needs Attentionice

⚠ Trailer Brakes Issue Description(Required)

Emergency Breakaway switch - Functional(Required)

Yes - Functional

⚠ Functional with concerns

⚠ No - Needs Attention

⚠ Emergency Breakaway Issue Description(Required)

Left Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Right Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Right Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Left Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Trailer Jack - Functional(Required)

Yes - Functional

⚠ Functional with concerns

⚠ No - Needs Attention

⚠ Trailer Jack Issue Description(Required)

Tool Bin - Condition(Required)

Good Physical Condition

⚠ Poor Physical Condition - Needs Replacement

Safety Chains - Condition(Required)

Good Physical Condition

⚠ Poor Physical Condition - Needs Replacement

Tie Down Straps - Condition(Required)

Good Physical Condition

⚠ Poor Physical Condition - Replacement Needed

Plow

Visual Inpection(Required)

Unit free from clumped dirt

⚠ Unit has excess dirt - needs attention

Plow Levers & Controls(Required)

Operational

⚠ not functioning correctly

⚠ Plow Lever's and Controls Issue Description

Warning Lights & Devices

Functional

⚠ not functioning correctly

⚠ Warning Lights & Device Issue Description(Required)

Left Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Right Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Right Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Left Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Plow Blade Condition(Required)

Good Condition

⚠ Poor Condition

Plow Blade alignment(Required)

Good Condition

⚠ Poor Condition

Plow Blade Pin condition(Required)

Good Condition

⚠ Poor Condition

Plow Blade Pin clasp condition(Required)

Good Condition

⚠ Poor Condition

Plow Battery condition(Required)

Good Condition

⚠ Poor Condition

Plow Motor Oil(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Plow Hydraulic fluid(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Excavator

Excavator Hours(Required)

Excavator Track Condition(Required)

Good Condition (rollers, idlers, sprockets)

⚠ No - Some Damaged /Bent/Broken

⚠ Excavator Track Condition Issue Description(Required)

Excavator Levers & Controls(Required)

Operational

⚠ not functioning correctly

⚠ Excavator Lever & Control Issue Description(Required)

Excavator Battery condition(Required)

Good Condition

⚠ Poor Condition

⚠ Excavator Battery Issue Description(Required)

Excavator Belt condition(Required)

Good Condition

⚠ Poor Condition

Excavator Motor Oil

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Excavator Hydraulic fluid(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Excavator Hydraulic Hoses condition(Required)

Good Condition

⚠ Damaged / Poor Condition - Needs Attention

⚠ Excavator Hydraulic Hose Issue Description(Required)

Excavator Hydraulic cylinders condition(Required)

Good Condition

⚠ Damaged / Poor Condition - Needs Attention

⚠ Excavator Hydraulic Cylinder Issue Description(Required)

Excavator Cooling System condition(Required)

Good Condition

⚠ Damaged / Poor Condition - Needs Attention

⚠ Excavator Cooling System Issue Description(Required)

Forklift

Visual Inspection(Required)

Unit is dry and free from clumped dirt

⚠ Unit has excess dirt/water - needs attention

Levers & Controls(Required)

Operational

⚠ not functioning correctly

Forklift: Lever's and Controls Issue Description(Required)

Warning Lights / Devices / Decals(Required)

Functional

⚠ not functioning correctly / missing

Wheel Condition(Required)

Left Front

Right Front

Right Rear

Left Rear

Forklift Motor Oil(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Forklift Hydraulic fluid(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Forklift Notes

Mobile Generator

Visual Inspection: Generator(Required)

Unit free from clumped dirt

⚠ Unit has excess dirt - needs attention

Generator Levers & Controls(Required)

Operational

⚠ not functioning correctly

Generator Lever's and Controls Issue Description(Required)

Generator: Gauges(Required)

Operational

⚠ not functioning correctly

Generator Gauge Issue Description(Required)

Generator: Warning Lights & Devices(Required)

Functional

⚠ not functioning correctly

Generator: Fuel Level(Required)

Full Tank

⚠ 3/4 Tank or less

Generator: Motor Oil(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Generator: Coolant(Required)

Fluid at correct Level / no visible leaks

Fluid at correct level / ⚠ leak present

⚠ Low on Fluid / no visible leaks

⚠ Low on Fluid / ⚠ leak present

Generator Trailer: Left Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Generator Trailer: Right Front Tire(Required)

Tread

Wear

Pressure

Sidewall

Generator Trailer: Right Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Generator Trailer: Left Rear Tire(Required)

Tread

Wear

Pressure

Sidewall

Form Maintenance section

Please note below anything of importance that could not be relayed properly above. Also give feedback as to if equipment may be labeled incorrectly, or is needing added or removed.

Notes