<Project Name>

< CLIENT LOGO >

Back Hoe Loader

Contractor: Doc. No :

Operator Name & Licence no Date:

2 5 1
5
3

3 4
2
8 9 7
6

S No. Description Yes No Remarks

Front & reverse horn available & in working
1
condition

2 Head & tail lamps(for working at night)

Leakage of oil(in hydraulic & pneumatic systems

3
has been checked)
Loose bolts /connecting pins(In bucket,doser and
4
all innks) has been checked

5 Back view mirror is available & condition is ok.

Roller-crawler / tire condition (check for damaged /

6
missing idle rollers)
Structure beem condition(damage,cut,crack) has
7
been checked and ok

8 Diesel, oil and grease spillage.

9 Fire extinguisher in operator cabin is available.

Swinging horn is available and in working

10
condition

11 Equipment having proper & valid documents

Crawler Excavator having Safe access And

12
Egress for Operator
Operator having license and (heavy duty). With
13
valid date.
Vehicle having valid insurance paper,Operator
14
having license & other necessary documents

Remarks

Contractor's Company Client's

Representative Representative Representative
Signature:

Name:
Date: