VIPR Fire Equipment Incident Inspection Checklist
April 1, 2015
EXCAVATOR INCIDENT INSPECTION CHECKLIST
INCIDENT NAME:
Date: ___________ Time: __________
___________________ INCIDENT NUMBER: ____________________ RESOURCE #: E-
COMPANY/CONTRACTOR:_________________________________________________________________
AGREEMENT NUMBER: ___________________________________________________________________
EQUIPMENT MAKE: _______________________________ MODEL: _______________________________
VIN/SERIAL #: ____________________________________________________________________________
OPERATOR NAME: ______________________________________________________________________________________
EQUIPMENT and OPERATOR REQUIREMENTS – EXCAVATOR
Type 1: 156+ HP
Type 2: 111 → 155 HP
Type 3: 81 → 110 HP
Type 4: 60 → 80 HP
Minimum Requirements
Not all inclusive; for additional clarification refer to agreement (SF-1449 section D)
1
2
3
Agreement (One complete copy)
Check-In Process Completed (Note: Also includes; Finance, and Plans)
VIN/Serial # matches Resource Order (may also have to verify on DPL):
that could affect payment.
4
5
6
7
8
9
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Yes
(D.8)
(D.6.5.3)
Note: This is also a business rule
(Schedule of Items) (D.6.3.1)
RT-130 Fire Line Refresher current for all personnel
Incident Pre-Use Inspection Completed
(OF-296 Vehicle/Heavy Equipment Mechanical Inspection)
Excavator arrived at incident washed: (Debris and noxious weeds free)
(D.3.1)
(D.17) (D.17.1)
(D.15)
Back-Up Alarm: (Audible reverse warning device)
(D.2.1.2)
Fire Extinguisher; 2A 10BC (with current annual maintenance tag)
(D.2.1.2)
Shovel
(D.2.1.2)
Flashlight
(D.2.1.2)
Water: (At least 1 gallon drinking water)
(D.2.1.2)
First aid kit: (5 person minimum)
(D.2.1.2)
PPE: Boots
Hard Hat
Gloves
Eye Protection
Hearing Protection
Headlamp with batteries
(D.2.1.2)
Fire Shelter: (New generation)
(D.2.1.2)
Flame Resistant Clothing: (Two full sets)
(D.2.1.2)
Operator Protection System: (Factory enclosed canopy with deflectors)
(D.2.1.2 excavators)
*Seat Belts
(D.2.1.2)
*Spark Arrester (Not Applicable: Turbo exhaust)
(D.2.1.2)
*Radiator Protection
(D.2.1.2)
All factory guards in place and functional (i.e. engine compartment)
(D.2.1.2)
Lighting: (2 lights forward)
(D.2.1.2 excavators_3)
Hydraulic: Thumb
- or - Clamshell
(D.2.1.2.excavators_4)
Steel Tracks
(D.2.1.2.excavators_5)
No
VIPR Fire Equipment Incident Inspection Checklist
25
26
April 1, 2015
Optional (attributes)
Up Down Blade – or – Dozer Blade:
Steep Ground Excavator (note: self leveling cab)
(D.6.2)
(D.6.2)
*Item may be waived if inspection successfully performed on the OF-296.
Equipment meets agreement specifications
Equipment does not meet agreement specifications
Inspector:
Date:
(Print and sign)
Contractor:
Date:
(Print and sign)
Contractor given the opportunity to correct noted deficiencies (See Remarks)
Contactor successfully corrected noted deficiencies
Inspector:
Date:
REMARKS:__________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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__________2015