SCOFIELD'S TOWING INC.

43 South Skiview Drive Beloit, Wisconsin 53511 608-921-0726

Driver's Daily Safety Maintence Sheet, Log Sheet, Mileage Sheet And Hours Of Duty Sheet
COMPLETION OF THIS REPORT IS REQUIRED BY FEDERAL MOTOR CARRIER SAFETY REGULATIONS SECTION 396.11 AND 396.13

Absolutely no people are allowed on tow truck bed or vehicle in tow.

Driver (initials) / Company / Scofield's Towing INC Make / Ford / Year - 1995 Model / Superduty Rollback License / Wisconsin / GD 33109 Vin # 1FDLF47F1SEA43518

Date End Mileage Start Mileage Total Mileage

Time in Time out

am / pm am / pm

Tire info. LT 235 / 85 R 16 120/1160 M+S Load Range E80 PSI. Check the following items each day when you start to work and again when you finish work When you start work, put a mark in the proper box like this / ( if there is no work, do not fill out sheet ) When you finish work, put a mark in the proper box like this \ No driver is to work over 10 hrs. straight without a min. of 10 hrs.off duty / Office hours are 9 am. To 7 pm. If more than 10 hrs. are needed, call office for instructions or call Tony or Ron @ 608-921-0726 Fill fuel tanks at end of your shift (turn in receipts to office). OK Needs corrective action. OK Needs corrective action.

Motor oil level (manual) Motor coolant (visual) Brake fluid level (visual) Headlamps (visual) Tail lamps (visual) Turn signals (visual) Four way warning lamps (visual) Towing lamps (on top)(visual) Work lamps (visual) Oil pressure (visual) Flashlight (in cab) (visual) Windshield wipers (visual) Back window (visual) Mirrors (visual) Windshield wipers (visual) Defroster / Fan (manual) Fuel in tanks ? ( check gage)
Comments or corrective action needed or done:

Winch line (Visual / badly frayed?) Winch mounting bolts ( visual / all there?) Hydraulic rams, hoses, valves (visual / leaks) Fire extinguisher (full?) (visual) Exhaust sys.(visual)(Listen for excessive noise) Hyd. fluid level (bottom of screen min)(visual) Unusual tire wear (visual) Low tire pressure (visual ) Frame (visiblecracks) (visual) Mud flaps (visual) Fuel tank caps (visual) Horn (push horn) Brakes (Check pedal w / motor running) Steering (with motor running / tight?) Parking brake(push E-brake down and move truck against it) Speedometer / tach (visual) Necessary tools to do job ? (visual)

Turn completed sheet into office at the end of your day, along with other reciepts, & work orders. Office will review comments or corrective action that is suggested, and if necessary, take the necessary steps to Repair invoice #__________________ correct the situation. Attach copy of Repair Invoice to this sheet Repairs completed by____________________________________________Date_________________________ Driver informed of Results. Date___________________Driver Signature________________________________________

SCOFIELD'S TOWING INC. 43 South Skiview Drive Beloit, Wisconsin 53511 608-921-0726