GENERAL EQUIPMENT INFORMATION
1. INCIDENT NAME/NO. 2. RESOURCE ORDER NO.
3. CONTRACTOR NAME
4. AGREEMENT NO. 5. EXPIRATION DATE
6. MAKE/MODEL 7. EQUIPMENT TYPE
8. VIN/SERIAL NO. 9. LICENSE NO./STATE
Section I—HEAVY EQUIPMENT
Acceptable
YES NO
1. ROPS, roll-over protection system: Manufacturer-approved
system secured to mainframe of tractor. Must include
approved seat belts.
*
2. Gauges and lights: mounted and function properly. *
3. Battery: check for corrosion, loose terminals, and hold downs.
4. Engine running: check oil pressure, knocks and leaks.
5. Sweeps, deectors, safety screensJODVV
*
6. Steering components: tight, free of play.
*
7. Brakes: damaged, worn or out of adjustment.
*
8. Exhaust system: equipped with a USFS-qualied spark
arrester unless turbocharged.
*
9. Fuel system: free of leaks and damage.
*
10. Cooling system: full, free of leaks and damage.
*
11. Fan and fan belts: check for proper tension. No fraying/cracks.
12. Engine support, equalizer bar, springs, main springs: check
shackle bolts, shifted spring leaf.
*
13. Belly plate, radiator guards: securely mounted and free from
debris.
*
14. Final drive, transmission and differential: check for dripping.
15. Sprocket and idlers: crack in spokes, sharp sprocket teeth,
no welds.
16. Tracks and rollers: no broken pads, loose rollers, broken
anges.*URXVHUKHLJKWPLQ
*
17. Dozer and assembly: trunnion bolts missing, cracks.
*
18. Rear hitch (drawbar): serviceable, safe.
19. Body and cab condition: describe dents and damage.
20. Equipment cleanliness: all areas free of ammable
materials, noxious weeds, and invasive species.
21. All hydraulic attachments: operate smoothly and all
cylinders hold at extension; hose, lines, and pumps have no
excessive wear and/or leaks.
22. Backup or travel alarm (minimum 87 dbl).
*
23. Oil level and condition: full and clean.
Section II—ATTACHMENTS/PUMP/CHAINSAW/OR
OTHER (Specify)
Acceptable
YES NO
1. No missing/broken components, no loose hardware.
2. Sufcient uid levels (oil, coolant, etc.)
3. Cutting bar: straight, chain in good condition.
4. Cutting teeth: sharp, good repair.
5. Pump: builds pressure, no water or oil leaks.
6. Engine starts, idles, and shuts off with switch.
10. PRE-USE INSPECTION
Accepted Rejected
MILES/HRS DATE TIME
Inspector’s printed name Title
Inspector’s signature
Section III—LIABILITY
The purpose of this checklist is to document pre-existing vehicle/equipment
condition and to determine suitability for incident use. I hereby acknowledge full
responsibility and liability for the operation and mechanical condition of the vehicle/
equipment described herein.
Operator’s printed name Title
Operator’s signature Date
Section IV—TRANSPORT OR SUPPORT VEHICLES
Acceptable
YES NO
1. “DOT” or CVSA inspection in the last 12 months (if required).
*
2. Gauges and lights: mounted and function properly.
*
3. Seat belts: operate properly for each seating position.
*
4. Glass and mirrors, no cracks in vision.
*
5. Wipers, washers, and horn operate properly.
*
6. Clutch pedal: proper adjustment (if applicable).
7. Cooling system: full, free of leaks and damage.
8. Fluid levels (e.g. oil) and condition: full and clean.
9. Battery: check for corrosion, loose terminals and hold downs.
10. Fuel system: free of leaks and damage.
*
11. Electrical system: alternator and starter work.
12. Engine running: check oil pressure, knocks, and leaks.
13. Transmission: check for leaks.
14. Steering components: tight, free of play.
*
15. Brakes: damaged, worn or out of adjustment.
*
16. 4-Wheel drive: check transfer case, leaks (if applicable).
17. Drive line U-joints: check for looseness.
18. Suspension systems: springs, shocks, other.
*
19. Differential(s): check for leaks.
20. Exhaust system: no leaks under cab or before turbo.
*
21. Frame condition, body/bed properly attached.
*
22. Tires/wheels (including spare and all changing equipment)
sufcient load rating, tread depth, no major damage.
*
23. Body and interior condition: describe and locate damage on
back of page 3, Section IV, item 23.
24. Emergency equipment required.
Fire extinguisher Spare fuses Reectors
*
25. Operator(s) properly licensed. † Expiration Date
State License No Class
Endorsement Med. Cert. Expiration Date
11. RELEASE
No Damage/No Claim
MILES/HRS DATE TIME
Operator’s printed name Title
Operator’s signature Date
Inspector’s printed name Title
Section V—REMARKS (Describe all unsatisfactory items and identify by line number)
VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST
Contractor ______________________________ Resource Order No. _____________
SEE SUPPLEMENTAL INFORMATION ON BACKSIDE OF CONTRACTOR COPY
7540-01-120-0607
PREVIOUS EDITION NOT USABLE
FINANCE COPY – PRE-USE
Printed on recycled paper
* Safety Item—Do not accept until brought into compliance.
† Include information for additional operators in REMARKS section.
OPTIONAL FORM 296 (REV. 2-2016)
50296-103
GENERAL EQUIPMENT INFORMATION
1. INCIDENT NAME/NO. 2. RESOURCE ORDER NO.
3. CONTRACTOR NAME
4. AGREEMENT NO. 5. EXPIRATION DATE
6. MAKE/MODEL 7. EQUIPMENT TYPE
8. VIN/SERIAL NO. 9. LICENSE NO./STATE
Section I—HEAVY EQUIPMENT
Acceptable
YES NO
1. ROPS, roll-over protection system: Manufacturer-approved
system secured to mainframe of tractor. Must include
approved seat belts.
*
2. Gauges and lights: mounted and function properly. *
3. Battery: check for corrosion, loose terminals, and hold downs.
4. Engine running: check oil pressure, knocks and leaks.
5. Sweeps, deectors, safety screensJODVV
*
6. Steering components: tight, free of play.
*
7. Brakes: damaged, worn or out of adjustment.
*
8. Exhaust system: equipped with a USFS-qualied spark
arrester unless turbocharged.
*
9. Fuel system: free of leaks and damage.
*
10. Cooling system: full, free of leaks and damage.
*
11. Fan and fan belts: check for proper tension. No fraying/cracks.
12. Engine support, equalizer bar, springs, main springs: check
shackle bolts, shifted spring leaf.
*
13. Belly plate, radiator guards: securely mounted and free from
debris.
*
14. Final drive, transmission and differential: check for dripping.
15. Sprocket and idlers: crack in spokes, sharp sprocket teeth,
no welds.
16. Tracks and rollers: no broken pads, loose rollers, broken
anges.*URXVHUKHLJKWPLQ
*
17. Dozer and assembly: trunnion bolts missing, cracks.
*
18. Rear hitch (drawbar): serviceable, safe.
19. Body and cab condition: describe dents and damage.
20. Equipment cleanliness: all areas free of ammable
materials, noxious weeds, and invasive species.
21. All hydraulic attachments: operate smoothly and all
cylinders hold at extension; hose, lines, and pumps have no
excessive wear and/or leaks.
22. Backup or travel alarm (minimum 87 dbl).
*
23. Oil level and condition: full and clean.
Section II—ATTACHMENTS/PUMP/CHAINSAW/OR
OTHER (Specify)
Acceptable
YES NO
1. No missing/broken components, no loose hardware.
2. Sufcient uid levels (oil, coolant, etc.)
3. Cutting bar: straight, chain in good condition.
4. Cutting teeth: sharp, good repair.
5. Pump: builds pressure, no water or oil leaks.
6. Engine starts, idles, and shuts off with switch.
10. PRE-USE INSPECTION
Accepted Rejected
MILES/HRS DATE TIME
Inspector’s printed name Title
Inspector’s signature
Section III—LIABILITY
The purpose of this checklist is to document pre-existing vehicle/equipment
condition and to determine suitability for incident use. I hereby acknowledge full
responsibility and liability for the operation and mechanical condition of the vehicle/
equipment described herein.
Operator’s printed name Title
Operator’s signature Date
Section IV—TRANSPORT OR SUPPORT VEHICLES
Acceptable
YES NO
1. “DOT” or CVSA inspection in the last 12 months (if required).
*
2. Gauges and lights: mounted and function properly.
*
3. Seat belts: operate properly for each seating position.
*
4. Glass and mirrors, no cracks in vision.
*
5. Wipers, washers, and horn operate properly.
*
6. Clutch pedal: proper adjustment (if applicable).
7. Cooling system: full, free of leaks and damage.
8. Fluid levels (e.g. oil) and condition: full and clean.
9. Battery: check for corrosion, loose terminals and hold downs.
10. Fuel system: free of leaks and damage.
*
11. Electrical system: alternator and starter work.
12. Engine running: check oil pressure, knocks, and leaks.
13. Transmission: check for leaks.
14. Steering components: tight, free of play.
*
15. Brakes: damaged, worn or out of adjustment.
*
16. 4-Wheel drive: check transfer case, leaks (if applicable).
17. Drive line U-joints: check for looseness.
18. Suspension systems: springs, shocks, other.
*
19. Differential(s): check for leaks.
20. Exhaust system: no leaks under cab or before turbo.
*
21. Frame condition, body/bed properly attached.
*
22. Tires/wheels (including spare and all changing equipment)
sufcient load rating, tread depth, no major damage.
*
23. Body and interior condition: describe and locate damage on
back of page 3, Section IV, item 23.
24. Emergency equipment required.
Fire extinguisher Spare fuses Reectors
*
25. Operator(s) properly licensed. † Expiration Date
State License No Class
Endorsement Med. Cert. Expiration Date
11. RELEASE
No Damage/No Claim
MILES/HRS DATE TIME
Operator’s printed name Title
Operator’s signature Date
Inspector’s printed name Title
Section V—REMARKS (Describe all unsatisfactory items and identify by line number)
VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST
Contractor ______________________________ Resource Order No. _____________
SEE SUPPLEMENTAL INFORMATION ON BACK
CONTRACTOR COPY - PRE-USE / RELEASE
* Safety Item—Do not accept until brought into compliance.
† Include information for additional operators in REMARKS section.
7540-01-120-0607
PREVIOUS EDITION NOT USABLE
OPTIONAL FORM 296 (REV. 2-2016)
50296-103
Section IV - Transport and Support Vehicles
Motor vehicle parts and accessories must be in Safe Operating Condition At All Times, FEDERAL MOTOR
CARRIER SAFETY ADMINISTRATION (FMCSA) as prescribed by U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION PARTS 393 & 396, and NORTH AMERICAN UNIFORM OUT-OF-SERVICE
CRITERIA, COMMERCIAL VEHICLE SAFETY ALLIANCE (CVSA).
REJECT IF: Parts and accessories covered in FMCSR part 393, 396 and/or CVSA North American Uniform Out-of-
service Criteria are not in safe and proper operating conditions at all times. These include, but are not limited to
the parts and accessories listed below.
2. Gauges and Lights (393.82, 393.11)
♦ Speedometerinoperative.
♦ Allrequiredlightingdevices,reectorsandelectricalequipmentmustbe
properlypositioned,coloredandworking.
3. Seat Belts (393.93)
♦ Anydriverorrightoutboardseatbeltmissingorinoperative.
4. Glass and Mirrors (393.60, 393.80)
♦ Anydiscolorationnotappliedbythemanufacturerforreductionofglare.
♦ Anywindshieldcrackover1/4”wide.
♦ Anycracklessthan1/4”widethatintersectswithanyothercrack.
♦ Anydamage3/4”orgreaterindiameter.
♦ Any2damagedareascloserthan3”toeachother.
♦ Anyrequiredmirrormissing.Oneoneachside,rmlyattachedtotheoutside
ofthevehicle,andsolocatedastoreecttothedriveraviewofthehighwayto
therearalongbothsidesofthevehicle.
♦ Anyrequiredmirrorbroken.
5. Wipers and Horn (393.78, 393.81)
♦ Wiperblade(s)failtocleanwindshieldwithin1”ofwindshieldsides.
♦ Hornmissing,inoperativeorfailstogiveadequate/reliablewarningsignal.
10. Fuel System (393.65, 393.67)
♦ Fueltanknotsecurelyattachedtovehiclebyreasonofloose,brokenormissing
mountingboltsorbrackets.
♦ Visibleleakatanypoint.
♦ Fueltankcapmissing.
14. Steering (393.209)
♦ Steeringwheeldoesnotturnfreely,hasanyspokescrackedthroughoris
missinganyparts.
♦ Steeringlashnotwithinparameters,seechartinFMCSA393.209.
♦ Steeringcolumnisnotsecure.
♦ Steeringsystem;anyU-jointworn,faultyorrepairedbywelding.
♦ Steeringgearboxisloose,crackedormissingmountingbolts.
♦ Pitmanarmisloose,orhasanyweldedrepairs.
♦ PowerSteering;anycomponentisinoperative.Anyloose,brokenormissing
parts.Beltsfrayed,crackedorslipping.
♦ Anyfluidleaks,fluidreservoirnotfull.
15. Brakes (393.40-393.55)
♦ BrakesystemhasanydeficienciesasdescribedinFMCSA.
♦ Brakesystemhasanymissing,loose,broken,outofadjustmentorwornout
components.
♦ Brakesystemfailurewarningdevicemissing,inoperative,orfailstogive
adequatewarning.
♦ Brakesystemhasanyairorfluidleaks.
18. Suspension Systems (393.207)
♦ Anyaxlepositioningpartiscracked,broken,looseormissing.Allaxlesmustbe
inproperalignment.
♦ Anyleafspringcracked,broken,missingorshiftedoutofposition.
♦ Adjustableaxleassemblieswithlockingpinsmissingornotengaged.
20. Exhaust (393.83)
♦ Anypartoftheexhaustsystemsolocatedaswouldbelikelytoresultin
charring,burning,ordamagingthewiring,fuelsupplyoranycombustiblepart
ofthevehicle.
♦ Busexhaustleaksordischargeforwardoftherearmostpartofthebusin
excessof6"forGasolinepoweredor15"forotherthanGasolinepowered,or
forwardofanydoororwindowdesignedtobeopenedonotherthanaGasoline
poweredbus.(Exception:emergencyexit).
♦ Anyleakatanypointforwardofordirectlybelowthedriverand/orsleeper
compartment.
21. Frame (393.201)
♦ Anycracked,broken,looseorsaggingframemember.
♦ Anylooseormissingfastenersincludingthoseattachingengine,transmission,
steeringgear,suspension,body,andfifthwheel.
♦ Anyconditionthatcausesthebodyorframetocontactthetireorwheel
assemblies.
22. Tires and Wheels (393.75, 393.205)
♦ Anybodyplyorbeltmaterialexposedthroughtreadorsidewall.
♦ Anytreadorsidewallseparation.
♦ Anycutexposingplyorbeltmaterial.
♦ Treaddepthslessthan4/32"onsteeringaxle.
♦ Lessthan2/32"onanyotheraxle.
♦ Anybuswithregrooved,recapped,orretreadedtiresonthefrontwheels.
♦ Anytirenotproperlyinflatedoranyoverloadedtire.
♦ Anytirethatcomesincontactwithanypartofthevehicle.
♦ Anytiremarked"NotforHighwayUse".
♦ Wheelsorrimsshallnotbecrackedorbroken.
♦ Studorboltholesonthewheelsshallnotbeelongated.
♦ Nutsorboltsshallnotbemissingorloose.
24. Emergency Equipment (393.95)
♦ Everypowerunitmustbeequippedwithafireextinguisherthatisproperlyfilled
andreadilyaccessibleforuse.
♦ Sparefusesorotheroverloadprotectivedevice.
♦ Warningdevicesforstoppedvehicles.
25. License (383.23, 391.41)
♦ Nopersonshalloperateacommercialmotorvehicleunlesssuchpersonhas
passedwrittenanddrivingtestswhichmeettheFederalStandardsforthe
commercialmotorvehiclethatpersonoperates.
♦ Personsshallnotdriveacommercialmotorvehicleunlesshe/sheisphysically
qualifiedtodosoandhasonhis/herpersontheoriginal,oraphotographic
copy,ofamedicalexaminer'scertificatethathe/sheisphysicallyqualified.
IN ADDITION TO THE ABOVE:
Agencypersonnelreservetherighttorejectanyequipmentduetoany
additionalconditionorcombinationofconditionsthatmakethevehicleunsafe,
unreliable,ormayposeunreasonabledamagetotheenvironment,orwillbe
unabletofullyperformthedutiesforwhichtheequipmenthasbeenhired.
The inspector shall inspect for compliance with
the FMCSA, State and Local laws and regulations.
Therefore, the Inspector must ACCEPT
or REJECT all equipment he/she inspects.
GENERAL EQUIPMENT INFORMATION
1. INCIDENT NAME/NO. 2. RESOURCE ORDER NO.
3. CONTRACTOR NAME
4. AGREEMENT NO. 5. EXPIRATION DATE
6. MAKE/MODEL 7. EQUIPMENT TYPE
8. VIN/SERIAL NO. 9. LICENSE NO./STATE
Section I—HEAVY EQUIPMENT
Acceptable
YES NO
1. ROPS, roll-over protection system: Manufacturer-approved
system secured to mainframe of tractor. Must include
approved seat belts.
*
2. Gauges and lights: mounted and function properly. *
3. Battery: check for corrosion, loose terminals, and hold downs.
4. Engine running: check oil pressure, knocks and leaks.
5. Sweeps, deectors, safety screensJODVV
*
6. Steering components: tight, free of play.
*
7. Brakes: damaged, worn or out of adjustment.
*
8. Exhaust system: equipped with a USFS-qualied spark
arrester unless turbocharged.
*
9. Fuel system: free of leaks and damage.
*
10. Cooling system: full, free of leaks and damage.
*
11. Fan and fan belts: check for proper tension. No fraying/cracks.
12. Engine support, equalizer bar, springs, main springs: check
shackle bolts, shifted spring leaf.
*
13. Belly plate, radiator guards: securely mounted and free from
debris.
*
14. Final drive, transmission and differential: check for dripping.
15. Sprocket and idlers: crack in spokes, sharp sprocket teeth,
no welds.
16. Tracks and rollers: no broken pads, loose rollers, broken
anges.*URXVHUKHLJKWPLQ
*
17. Dozer and assembly: trunnion bolts missing, cracks.
*
18. Rear hitch (drawbar): serviceable, safe.
19. Body and cab condition: describe dents and damage.
20. Equipment cleanliness: all areas free of ammable
materials, noxious weeds, and invasive species.
21. All hydraulic attachments: operate smoothly and all
cylinders hold at extension; hose, lines, and pumps have no
excessive wear and/or leaks.
22. Backup or travel alarm (minimum 87 dbl).
*
23. Oil level and condition: full and clean.
Section II—ATTACHMENTS/PUMP/CHAINSAW/OR
OTHER (Specify)
Acceptable
YES NO
1. No missing/broken components, no loose hardware.
2. Sufcient uid levels (oil, coolant, etc.)
3. Cutting bar: straight, chain in good condition.
4. Cutting teeth: sharp, good repair.
5. Pump: builds pressure, no water or oil leaks.
6. Engine starts, idles, and shuts off with switch.
10. PRE-USE INSPECTION
Accepted Rejected
MILES/HRS DATE TIME
Inspector’s printed name Title
Inspector’s signature
Section III—LIABILITY
The purpose of this checklist is to document pre-existing vehicle/equipment
condition and to determine suitability for incident use. I hereby acknowledge full
responsibility and liability for the operation and mechanical condition of the vehicle/
equipment described herein.
Operator’s printed name Title
Operator’s signature Date
Section IV—TRANSPORT OR SUPPORT VEHICLES
Acceptable
YES NO
1. “DOT” or CVSA inspection in the last 12 months (if required).
*
2. Gauges and lights: mounted and function properly.
*
3. Seat belts: operate properly for each seating position.
*
4. Glass and mirrors, no cracks in vision.
*
5. Wipers, washers, and horn operate properly.
*
6. Clutch pedal: proper adjustment (if applicable).
7. Cooling system: full, free of leaks and damage.
8. Fluid levels (e.g. oil) and condition: full and clean.
9. Battery: check for corrosion, loose terminals and hold downs.
10. Fuel system: free of leaks and damage.
*
11. Electrical system: alternator and starter work.
12. Engine running: check oil pressure, knocks, and leaks.
13. Transmission: check for leaks.
14. Steering components: tight, free of play.
*
15. Brakes: damaged, worn or out of adjustment.
*
16. 4-Wheel drive: check transfer case, leaks (if applicable).
17. Drive line U-joints: check for looseness.
18. Suspension systems: springs, shocks, other.
*
19. Differential(s): check for leaks.
20. Exhaust system: no leaks under cab or before turbo.
*
21. Frame condition, body/bed properly attached.
*
22. Tires/wheels (including spare and all changing equipment)
sufcient load rating, tread depth, no major damage.
*
23. Body and interior condition: describe and locate damage on
back of page 3, Section IV, item 23.
24. Emergency equipment required.
Fire extinguisher Spare fuses Reectors
*
25. Operator(s) properly licensed. † Expiration Date
State License No Class
Endorsement Med. Cert. Expiration Date
11. RELEASE
No Damage/No Claim
MILES/HRS DATE TIME
Operator’s printed name Title
Operator’s signature Date
Inspector’s printed name Title
Section V—REMARKS (Describe all unsatisfactory items and identify by line number)
VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST
Contractor ______________________________ Resource Order No. _____________
SEE SUPPLEMENTAL INFORMATION
ON
BACKSIDE
OF CONTRACTOR COPY
FINANCE COPY - RELEASE
* Safety Item—Do not accept until brought into compliance.
† Include information for additional operators in REMARKS section.
7540-01-120-0607
PREVIOUS EDITION NOT USABLE
OPTIONAL FORM 296 (REV. 2-2016)
50296-103
Section IV, Item 23 - Truck, Bus, Van, Pickup, Body Condition Inspection
Pre-Use Inspection Release Inspection
Remarks
OPTIONAL FORM 296
GENERAL EQUIPMENT INFORMATION
1. INCIDENT NAME/NO. 2. RESOURCE ORDER NO.
3. CONTRACTOR NAME
4. AGREEMENT NO. 5. EXPIRATION DATE
6. MAKE/MODEL 7. EQUIPMENT TYPE
8. VIN/SERIAL NO. 9. LICENSE NO./STATE
Section I—HEAVY EQUIPMENT
Acceptable
YES NO
1. ROPS, roll-over protection system: Manufacturer-approved
system secured to mainframe of tractor. Must include
approved seat belts.
*
2. Gauges and lights: mounted and function properly. *
3. Battery: check for corrosion, loose terminals, and hold downs.
4. Engine running: check oil pressure, knocks and leaks.
5. Sweeps, deectors, safety screensJODVV
*
6. Steering components: tight, free of play.
*
7. Brakes: damaged, worn or out of adjustment.
*
8. Exhaust system: equipped with a USFS-qualied spark
arrester unless turbocharged.
*
9. Fuel system: free of leaks and damage.
*
10. Cooling system: full, free of leaks and damage.
*
11. Fan and fan belts: check for proper tension. No fraying/cracks.
12. Engine support, equalizer bar, springs, main springs: check
shackle bolts, shifted spring leaf.
*
13. Belly plate, radiator guards: securely mounted and free from
debris.
*
14. Final drive, transmission and differential: check for dripping.
15. Sprocket and idlers: crack in spokes, sharp sprocket teeth,
no welds.
16. Tracks and rollers: no broken pads, loose rollers, broken
anges.*URXVHUKHLJKWPLQ
*
17. Dozer and assembly: trunnion bolts missing, cracks.
*
18. Rear hitch (drawbar): serviceable, safe.
19. Body and cab condition: describe dents and damage.
20. Equipment cleanliness: all areas free of ammable
materials, noxious weeds, and invasive species.
21. All hydraulic attachments: operate smoothly and all
cylinders hold at extension; hose, lines, and pumps have no
excessive wear and/or leaks.
22. Backup or travel alarm (minimum 87 dbl).
*
23. Oil level and condition: full and clean.
Section II—ATTACHMENTS/PUMP/CHAINSAW/OR
OTHER (Specify)
Acceptable
YES NO
1. No missing/broken components, no loose hardware.
2. Sufcient uid levels (oil, coolant, etc.)
3. Cutting bar: straight, chain in good condition.
4. Cutting teeth: sharp, good repair.
5. Pump: builds pressure, no water or oil leaks.
6. Engine starts, idles, and shuts off with switch.
10. PRE-USE INSPECTION
Accepted Rejected
MILES/HRS DATE TIME
Inspector’s printed name Title
Inspector’s signature
Section III—LIABILITY
The purpose of this checklist is to document pre-existing vehicle/equipment
condition and to determine suitability for incident use. I hereby acknowledge full
responsibility and liability for the operation and mechanical condition of the vehicle/
equipment described herein.
Operator’s printed name Title
Operator’s signature Date
Section IV—TRANSPORT OR SUPPORT VEHICLES
Acceptable
YES NO
1. “DOT” or CVSA inspection in the last 12 months (if required).
*
2. Gauges and lights: mounted and function properly.
*
3. Seat belts: operate properly for each seating position.
*
4. Glass and mirrors, no cracks in vision.
*
5. Wipers, washers, and horn operate properly.
*
6. Clutch pedal: proper adjustment (if applicable).
7. Cooling system: full, free of leaks and damage.
8. Fluid levels (e.g. oil) and condition: full and clean.
9. Battery: check for corrosion, loose terminals and hold downs.
10. Fuel system: free of leaks and damage.
*
11. Electrical system: alternator and starter work.
12. Engine running: check oil pressure, knocks, and leaks.
13. Transmission: check for leaks.
14. Steering components: tight, free of play.
*
15. Brakes: damaged, worn or out of adjustment.
*
16. 4-Wheel drive: check transfer case, leaks (if applicable).
17. Drive line U-joints: check for looseness.
18. Suspension systems: springs, shocks, other.
*
19. Differential(s): check for leaks.
20. Exhaust system: no leaks under cab or before turbo.
*
21. Frame condition, body/bed properly attached.
*
22. Tires/wheels (including spare and all changing equipment)
sufcient load rating, tread depth, no major damage.
*
23. Body and interior condition: describe and locate damage on
back of page 3, Section IV, item 23.
24. Emergency equipment required.
Fire extinguisher Spare fuses Reectors
*
25. Operator(s) properly licensed. † Expiration Date
State License No Class
Endorsement Med. Cert. Expiration Date
11. RELEASE
No Damage/No Claim
MILES/HRS DATE TIME
Operator’s printed name Title
Operator’s signature Date
Inspector’s printed name Title
Section V—REMARKS (Describe all unsatisfactory items and identify by line number)
VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST
Contractor ______________________________ Resource Order No. _____________
OPTIONAL FORM 296
SEE SUPPLEMENTAL INFORMATION ON BACKSIDE OF CONTRACTOR COPY
INSPECTOR COPY - PRE-USE RELEASE
OPTIONAL FORM 296 (REV. 2-2016
)
50296-103
* Safety Item—Do not accept until brought into compliance.
† Include information for additional operators in REMARKS section.
7540-01-120-0607
PREVIOUS EDITION NOT USABLE