Anda di halaman 1dari 1

GRADER INSPECTION FORM

Equipment Model (Specify) :

Registration No. : Operator Name :

Identification / Plate No : ID No :

Date and Time of Inspection : Certificate No :

Location : Company :

First Inspection Second Inspection Third Inspection


S/No. Items Inspected
Pass Fail Pass Fail Pass Fail
1 Upper Carriage condition / Interior House Keeping

2 Sport lights / Rotating Beacon light function.

3 Ignition switch / Engine stop mechanism.

4 Preventive maintenance Record.

5 Fan belt condition.

6 Battery condition

7 Rotary Component Lubrication.

8 Mirror condition.

9 Drive Belts Condition.

10 Government / 3rd Party Certification provided (if required)

11 Tire condition

12 Fire extinguisher Charged.

13 Blade condition (cracks, damage)

14 Blade lifts and Tilt cylinder leakages / conditions.

15 Brake System Function.

16 Engine Oil / Coolant / Hydraulic Oil level.

17 Backup alarm/ Horn Function.

18 Gauges, warning indicators, Switches controls.

19 Overall Engine / Exhaust System Condition.

20 Hydraulic Hose Fatigue / Damage / Leakages.

21 Hydraulic Oil / Transmission Oil Leakages.

22 Seat belt condition


Inspected By:

Subcontractor Heavy Equipment Inspector


(Sign/Date) (Sign/Date) (Sign/Date)

Contractor Vehicle / Mobile Equipment Inspector


(Sign/Date) (Sign/Date) (Sign/Date)
Remarks:
__________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________

Subcontractor Company: Sticker Number Issued (If pass)

Noted by Contractor HSSE Manager