VIPR Fire Equipment Incident Inspection Checklist
SKIDGINE INCIDENT INSPECTION CHECKLIST
INCIDENT NAME:
April 1, 2015
Date: ___________ Time: __________
___________________ INCIDENT NUMBER: ____________________ RESOURCE #: E-
COMPANY/CONTRACTOR:_________________________________________________________________
AGREEMENT NUMBER: ___________________________________________________________________
EQUIPMENT MAKE: _______________________________ MODEL: _______________________________
VIN/SERIAL #: ____________________________________________________________________________
OPERATOR NAME: ______________________________________________________________________________________
EQUIPMENT and OPERATOR REQUIREMENTS SKIDGINE
Type 1
Type 2
Type 3
Type 4
(see table below for minimum requirements)
Minimum Requirements
Not all inclusive; for additional clarification refer to agreement (SF-1449 section D)
1
2
3
is also a business rule that could affect payment.
4
5
6
7
Yes
Agreement (One complete copy)
(D.8)
Check-In Process: Completed (Note: Also includes; Finance, and Plans)
(D.6.5.3)
Equipment VIN/Serial # matches Resource Order (may also have to verify on DPL): Note: This
RT-130 Fire Line Refresher current for all personnel
Incident Pre-Use Inspection Completed
(Schedule of Items) (D.6.3.1)
(D.3.1)
(OF-296 Vehicle/Heavy Equipment Mechanical Inspection)
Equipment arrived at incident washed: (Debris and noxious weeds free)
(D.17) (D.17.1)
(D.15)
Written “Aftermarket” certification: Original manufacture design limits of equipment has not been
compromised, and mounting hardware is rated for the load secured.
(D.2.1.2)
8
*Rollover Protective Structure (ROPS): A manufactures nameplate certifying the operator enclosure
9
or alternative documentation that the cab meets these provisions is required
(D.2.1.2)
Operator Protection: Forestry cab which meets all applicable federal and state (the state where equipment
is registered) safety standards (per OSHA, 29 CFR 1910.266) for the year machine was constructed
(D.2.1.1)
(D.2.1.2)
10 Deflectors: Installed in front of the operator
(D.2.1.2)
11 *Underbody protection: Belly pan, rock guards unless not recommended by manufacturer
12 Tank baffling: One longitudinal baffle and one transverse baffle every 52” or free floating baffle system
13
with data sheets that validates baffling is sufficient to meet manufactures recommendation
(D.2.1.2)
Tank: Securely attached to the chassis. Fiberglass or plastic tanks must be surrounded by steel to prevent
puncture damage.
(D.2.1.2)
14 Rubber Tires: All tires shall have sound sidewalls and adequate tire tread depth to hold tire chains. Chains are optional
in the Pacific Northwest Region (R6) but required in all other Regions.
15
16
17
18
19
20
(D.2.1.2.2)
Fire Extinguisher: 2A 10BC, with current inspection tag. Securely mounted to vehicle
(D.2.1.2)
*Seat Belt(s)
(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)
No
VIPR Fire Equipment Incident Inspection Checklist
April 1, 2015
21 Fire Shelter: New generation shelter
22 Flame Resistant Clothing: Two Full Sets
(D.2.1.2)
(D.2.1.2)
Equipment Inventory
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
(Exhibit M)
Hose Reel: Operational, minimum 150 feet of 1 inch hard line hose
(D.2.1.2.2)
Hose, 1 inch: Minimum of 300’ type 1 &2, 300’ type 3 &4
(D.2.1.2.2)
Hose, 1 ½”: Minimum of 300’ type 1 &2
(D.2.1.2.2)
Hose Clamp: Forestry type. 1 each
Spanner Wrench: Combination 1 inch to 2 inch.
1 each
Nozzles: Combination fog / straight stream.
2 each.
Fitting: Double Male, 1 inch NPSH.
1 each
Fitting: Double Female, 1 inch NPSH.
1 each
Adapter: 1 inch NH Female to 1inch NPSH Male. 1 each
Adapter: 1 inch NPSH Female to 1 inch NH Male. 1 each
Reducer: 1 ½ inch NH Female to 1 inch NPSH Male. 1 each
Reducer: 1 inch NPSH to ¾ inch (garden hose). 1 each
Shovel: 1 each
Pulaski: 1 each
Discharge Outlet: 1 ½” NH Type 1 &2, 1” NPSH Type 3 &4
(D.2.1.2.2)
Fill Pipe: 4 inch minimum
Dump Valve: 3 inch minimum. Capable of dumping into a port-a-tank
Pump: Pump Type
Auxiliary
or Power Take Off (PTO)
(D.2.1.2)
Auxiliary pump (if equipped): Fuel to operate pump, minimum 5 gallons and Pump
accessories ( i.e. Pliers, Oil, Screwdrivers etc.)
42
43
44
45
--46
47
48
49
Pump: Discharge Pressure Gauge
Pump: 20 foot suction hose
Lighting: Minimum 2 rear, 2 forward
Back-Up Alarm: Audible reverse warning device.
****(Optional/Attributes)****
Winch
Grapple
(Type 3 or 4 only)
Foam Proportioner System: Manual
Automatic
Compressed Air Foam System:
Drop Tank Skidgine: Type 3 & 4 only, must have a log grapple
*Item may be waived if inspection successfully performed on the OF-296
Equipment meets agreement specifications
(D.2.1.2)
(D.2.1.2)
----(D.2.1.2.2) (D.6.2)
(D.2.1.2.2) ( D.6.2)
(D.2.1.2.1)
(D.2.1.2.2)
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:
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VIPR Fire Equipment Incident Inspection Checklist
April 1, 2015
REMARKS:__________________________________________________________________________________
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