Post Incident Inspection Non-Motorized

This equipment has been removed from service in AssetWORKS and tagged out.*

The SafetyNet Case Number is Available

Asset Number*

Equipment Type*

Please use 25 characters or less.

Date of Incident*

Last PMI Date*

Email Address of Inspecting Technician*

Customer Reported Failure(s)*

Please make sure all text is visible at the same time in this textbox.

Select all that are true of the Braking System.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is unrelated to this equipment ***

Brakes securely hold unit when applied.

Latching/holding device(s) work(s) properly.

All components are securely mounted and in good condition.

Cables and Linkages are properly adjusted.

Friction surfaces are in good condition and have sufficient life remaining.

None of the related statements are true.

Select all that are true of the Steering System.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is not related to this equipment ***

Steering turns freely from stop to stop.

All nuts, bolts, and fasteners are secure and according to specification.

Pivoting, rotating, and sliding mechanisms are properly lubricated.

Tie rod ends, axle, and pivot points are in good condition.

Steering does not have excessive play.

Steering is properly centered.

None are true.

Select all that are true of the Towing Device.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is not related to this equipment ***

Tow bar, tow eye, connection points, and all other related components are in good condition.

All nuts, bolts, and related hardware are secure and according to specification.

Pivots, latches, and general function are properly operating.

None are true.

Select all that are true of the Hitch.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is not related to this equipment ***

Hitch has all parts (spring, roll pin).

Hitch is not damaged and does not have excessive wear.

Hitch does not have excessive play or improper interface or improper operation.

Handle is in good condition.

Pin spring has resistive effort of at least 12 lbs. at 1/2” of lift.

None are true.

Select all that are true of the Axles & Wheels.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is not related to this equipment ***

Wheels and Tires are not damaged or excessively worn.

Axles and hubs are not damaged or excessively worn.

All nuts, bolts, and other fasteners are securely fastened.

Wheels and tires operate properly.

Tires are properly inflated.

Wheel bearings are properly lubricated.

None are true.

Select all that are true of the Electrical System.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is not related to this equipment ***

There are no potential fire hazards (exposed wires, shorts, etc.).

All emergency stops (E-STOPS) operate correctly.

All connections are secure.

All protective devices (i.e., Fuses, Circuit Breakers, etc.) are present and in good condition.

Battery is securely mounted and in good condition.

None are true.

Select all that are true of the Hydraulic System.*

*** ☐ = Fail . . . ☑ = Pass OR the statement is not related to this equipment ***

Hydraulic components are not damaged, worn, or fatigued.

All proper nuts, bolts, and other fasteners are in place and secure.

Fluid level is within the proper range.

No fluid leaks are detectable.

Hydraulic fluid is in good condition (i.e., not milky, cloudy, contaminated, etc.).

Reservoir cap is secure and sealed.

Hydraulically controlled systems are operating properly.

None are true.

Required bumpers, padding and other safety devices are present, securely fastened and in good condition.*

True

False

Equipment is an Aircraft Tow Bar.*

True

False

Notes

If there are not any findings for the fields in this section, enter "None found."

Note any defects or failures of any mechanical mechanisms or assemblies.*

Note any damage to frame, body, tube, roof, panels, doors, or other components.*

Review the last 12 months of AssetWorks history and note any repeated problems or related issues..*

Inspection Time + Estimated Repair Time (hours)*

Estimated Cost of Parts & Materials*

Inspection Recipient*

Who will be attaching this inspection to the Work Order?

Select or enter value

I understand that equipment involved in incidents must NOT be repaired until this checklist has been reviewed and approved by GSE Safety.*

Send me a copy of my responses