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The 296 Form functions as a critical Vehicle and Heavy Equipment Pre-Use Inspection Checklist, ensuring that operators assess essential equipment before deployment. The form captures vital information, such as the incident name, contractor name, and various equipment details, including make, model, and serial numbers. Using this checklist, inspectors thoroughly evaluate heavy equipment, checking for adherence to safety standards, mechanical functionality, and the presence of necessary safety features. Items inspected range from rollover protection systems and gauges to fluid levels and engine performance. The checklist also includes sections for assessing attachments and support vehicles, ensuring that all aspects of the equipment are deemed safe for operation. Operators must acknowledge their responsibility for the equipment's condition, highlighting the importance of maintaining safe practices. Proper use of this form can prevent accidents and incidents, safeguarding both personnel and the environment during operations.

296 Example

VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST

GENERAL EQUIPMENT INFORMATION

1.

INCIDENT NAME/NO.

2. RESOURCE ORDER NO.

 

 

 

 

 

 

3.

CONTRACTOR NAME

 

 

 

 

 

 

 

 

 

4.

AGREEMENT NO.

 

5. EXPIRATION DATE

 

 

 

 

 

 

6.

MAKE/MODEL

7. EQUIPMENT TYPE

 

 

 

 

 

 

 

8.

VIN/SERIAL NO.

 

9. LICENSE NO./STATE

 

 

 

 

 

 

 

 

 

 

 

 

Section I—HEAVY EQUIPMENT

 

 

 

Acceptable

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

1. ROPS, roll-over protection system: Manufacturer-approved

 

 

 

system secured to mainframe of tractor. Must include

*

 

 

approved seat belts.

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

3.Battery: check for corrosion, loose terminals, and hold downs.

4.Engine running: check oil pressure, knocks and leaks.

5.

Sweeps, delectors, safety screensJODVV

*

6.

Steering components: tight, free of play.

*

7.

Brakes: damaged, worn or out of adjustment.

*

8. Exhaust system: equipped with a USFS-qualiied spark

*

 

arrester unless turbocharged.

 

 

 

 

 

9.

Fuel system: free of leaks and damage.

*

10.

Cooling system: full, free of leaks and damage.

*

11. Fan and fan belts: check for proper tension. No fraying/cracks.

 

 

 

 

12.

Engine support, equalizer bar, springs, main springs: check

*

 

shackle bolts, shifted spring leaf.

 

13.

Belly plate, radiator guards: securely mounted and free from

*

 

debris.

 

14.

Final drive, transmission and differential: check for dripping.

 

 

 

 

15.

Sprocket and idlers: crack in spokes, sharp sprocket teeth,

 

 

no welds.

 

 

 

 

16.

Tracks and rollers: no broken pads, loose rollers, broken

*

 

langes.*URXVHUKHLJKWPLQ

 

 

17.

Dozer and assembly: trunnion bolts missing, cracks.

*

18.Rear hitch (drawbar): serviceable, safe.

19.Body and cab condition: describe dents and damage.

20.Equipment cleanliness: all areas free of lammable materials, noxious weeds, and invasive species.

21.All hydraulic attachments: operate smoothly and all cylinders hold at extension; hose, lines, and pumps have no excessive wear and/or leaks.

22. Backup or travel alarm (minimum 87 dbl).

*

23. Oil level and condition: full and clean.

Section II—ATTACHMENTS/PUMP/CHAINSAW/OR

Acceptable

 

OTHER (Specify)

 

 

YES NO

 

1.No missing/broken components, no loose hardware.

2.Suficient luid levels (oil, coolant, etc.)

3.Cutting bar: straight, chain in good condition.

4.Cutting teeth: sharp, good repair.

5.Pump: builds pressure, no water or oil leaks.

6.Engine starts, idles, and shuts off with switch.

10. PRE-USE INSPECTION

 

 

 

Accepted

Rejected

MILES/HRS

 

 

 

DATE

 

TIME

 

Inspector’s printed name

 

 

 

Title

 

 

Inspector’s signature

 

 

 

 

 

 

 

Section III—LIABILITY

The purpose of this checklist is to document pre-existing vehicle/equipment condition and to determine suitability for incident use. I hereby acknowledge full responsibility and liability for the operation and mechanical condition of the vehicle/ equipment described herein.

Operator’s printed name

 

 

Title

 

 

Operator’s signature

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV—TRANSPORT OR SUPPORT VEHICLES

Acceptable

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

“DOT” or CVSA inspection in the last 12 months (if required). *

 

 

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

 

 

 

 

 

 

 

 

 

 

 

3.

Seat belts: operate properly for each seating position.

*

 

 

 

 

 

 

 

 

 

 

 

4.

Glass and mirrors, no cracks in vision.

*

 

 

 

 

 

 

 

 

 

 

 

5.

Wipers, washers, and horn operate properly.

*

 

 

6.Clutch pedal: proper adjustment (if applicable).

7.Cooling system: full, free of leaks and damage.

8.Fluid levels (e.g. oil) and condition: full and clean.

9.Battery: check for corrosion, loose terminals and hold downs.

10. Fuel system: free of leaks and damage.

*

11.Electrical system: alternator and starter work.

12.Engine running: check oil pressure, knocks, and leaks.

13.Transmission: check for leaks.

14.

Steering components: tight, free of play.

*

 

 

 

15.

Brakes: damaged, worn or out of adjustment.

*

16.4-Wheel drive: check transfer case, leaks (if applicable).

17.Drive line U-joints: check for looseness.

18.

Suspension systems: springs, shocks, other.

*

 

 

 

19.

Differential(s): check for leaks.

 

 

 

 

20.

Exhaust system: no leaks under cab or before turbo.

*

 

 

 

21.

Frame condition, body/bed properly attached.

*

 

 

 

22.

Tires/wheels (including spare and all changing equipment)

*

suficient load rating, tread depth, no major damage.

23.Body and interior condition: describe and locate damage on back of page 3, Section IV, item 23.

24. Emergency equipment required.

*

 

Fire extinguisher

 

Spare fuses

 

 

Relectors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25. Operator(s) properly licensed. †

Expiration Date

 

 

State

 

 

License No

 

 

 

 

 

 

 

 

Class

 

 

Endorsement

 

 

 

 

 

 

 

 

 

Med. Cert. Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. RELEASE

 

 

 

 

 

 

 

No Damage/No Claim

MILES/HRS

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

TIME

 

 

Operator’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Operator’s signature

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

Inspector’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Contractor ______________________________ Resource Order No. _____________

Section V—REMARKS

(Describe all unsatisfactory items and identify by line number)

 

 

 

 

 

 

* Safety Item—Do not accept until brought into compliance.

† Include information for additional operators in REMARKS section. SEE SUPPLEMENTAL INFORMATION ON BACKSIDE OF CONTRACTOR COPY

7540-01-120-0607

Printed on recycled paper

PREVIOUS EDITION NOT USABLE

 

FINANCE COPY – PRE-USE

OPTIONAL FORM 296 (REV. 2-2016) 50296-103

VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST

GENERAL EQUIPMENT INFORMATION

1.

INCIDENT NAME/NO.

2. RESOURCE ORDER NO.

 

 

 

 

 

 

3.

CONTRACTOR NAME

 

 

 

 

 

 

 

 

 

4.

AGREEMENT NO.

 

5. EXPIRATION DATE

 

 

 

 

 

 

6.

MAKE/MODEL

7. EQUIPMENT TYPE

 

 

 

 

 

 

 

8.

VIN/SERIAL NO.

 

9. LICENSE NO./STATE

 

 

 

 

 

 

 

 

 

 

 

 

Section I—HEAVY EQUIPMENT

 

 

 

Acceptable

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

1. ROPS, roll-over protection system: Manufacturer-approved

 

 

 

system secured to mainframe of tractor. Must include

*

 

 

approved seat belts.

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

3.Battery: check for corrosion, loose terminals, and hold downs.

4.Engine running: check oil pressure, knocks and leaks.

5.

Sweeps, delectors, safety screensJODVV

*

6.

Steering components: tight, free of play.

*

7.

Brakes: damaged, worn or out of adjustment.

*

8. Exhaust system: equipped with a USFS-qualiied spark

*

 

arrester unless turbocharged.

 

 

 

 

 

9.

Fuel system: free of leaks and damage.

*

10.

Cooling system: full, free of leaks and damage.

*

11. Fan and fan belts: check for proper tension. No fraying/cracks.

 

 

 

 

12.

Engine support, equalizer bar, springs, main springs: check

*

 

shackle bolts, shifted spring leaf.

 

13.

Belly plate, radiator guards: securely mounted and free from

*

 

debris.

 

14.

Final drive, transmission and differential: check for dripping.

 

 

 

 

15.

Sprocket and idlers: crack in spokes, sharp sprocket teeth,

 

 

no welds.

 

 

 

 

16.

Tracks and rollers: no broken pads, loose rollers, broken

*

 

langes.*URXVHUKHLJKWPLQ

 

 

17.

Dozer and assembly: trunnion bolts missing, cracks.

*

18.Rear hitch (drawbar): serviceable, safe.

19.Body and cab condition: describe dents and damage.

20.Equipment cleanliness: all areas free of lammable materials, noxious weeds, and invasive species.

21.All hydraulic attachments: operate smoothly and all cylinders hold at extension; hose, lines, and pumps have no excessive wear and/or leaks.

22. Backup or travel alarm (minimum 87 dbl).

*

23. Oil level and condition: full and clean.

Section II—ATTACHMENTS/PUMP/CHAINSAW/OR

Acceptable

 

OTHER (Specify)

 

 

YES NO

 

1.No missing/broken components, no loose hardware.

2.Suficient luid levels (oil, coolant, etc.)

3.Cutting bar: straight, chain in good condition.

4.Cutting teeth: sharp, good repair.

5.Pump: builds pressure, no water or oil leaks.

6.Engine starts, idles, and shuts off with switch.

10. PRE-USE INSPECTION

 

 

 

Accepted

Rejected

MILES/HRS

 

 

 

DATE

 

TIME

 

Inspector’s printed name

 

 

 

Title

 

 

Inspector’s signature

 

 

 

 

 

 

 

Section III—LIABILITY

The purpose of this checklist is to document pre-existing vehicle/equipment condition and to determine suitability for incident use. I hereby acknowledge full responsibility and liability for the operation and mechanical condition of the vehicle/ equipment described herein.

Operator’s printed name

 

 

Title

 

 

Operator’s signature

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV—TRANSPORT OR SUPPORT VEHICLES

Acceptable

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

“DOT” or CVSA inspection in the last 12 months (if required). *

 

 

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

 

 

 

 

 

 

 

 

 

 

 

3.

Seat belts: operate properly for each seating position.

*

 

 

 

 

 

 

 

 

 

 

 

4.

Glass and mirrors, no cracks in vision.

*

 

 

 

 

 

 

 

 

 

 

 

5.

Wipers, washers, and horn operate properly.

*

 

 

6.Clutch pedal: proper adjustment (if applicable).

7.Cooling system: full, free of leaks and damage.

8.Fluid levels (e.g. oil) and condition: full and clean.

9.Battery: check for corrosion, loose terminals and hold downs.

10. Fuel system: free of leaks and damage.

*

11.Electrical system: alternator and starter work.

12.Engine running: check oil pressure, knocks, and leaks.

13.Transmission: check for leaks.

14.

Steering components: tight, free of play.

*

 

 

 

15.

Brakes: damaged, worn or out of adjustment.

*

16.4-Wheel drive: check transfer case, leaks (if applicable).

17.Drive line U-joints: check for looseness.

18.

Suspension systems: springs, shocks, other.

*

 

 

 

19.

Differential(s): check for leaks.

 

 

 

 

20.

Exhaust system: no leaks under cab or before turbo.

*

 

 

 

21.

Frame condition, body/bed properly attached.

*

 

 

 

22.

Tires/wheels (including spare and all changing equipment)

*

suficient load rating, tread depth, no major damage.

23.Body and interior condition: describe and locate damage on back of page 3, Section IV, item 23.

24. Emergency equipment required.

*

 

Fire extinguisher

 

Spare fuses

 

 

Relectors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25. Operator(s) properly licensed. †

Expiration Date

 

 

State

 

 

License No

 

 

 

 

 

 

 

 

Class

 

 

Endorsement

 

 

 

 

 

 

 

 

 

Med. Cert. Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. RELEASE

 

 

 

 

 

 

 

No Damage/No Claim

MILES/HRS

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

TIME

 

 

Operator’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Operator’s signature

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

Inspector’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Contractor ______________________________ Resource Order No. _____________

Section V—REMARKS

(Describe all unsatisfactory items and identify by line number)

 

 

 

 

 

 

 

 

*Safety Item—Do not accept until brought into compliance.SEE SUPPLEMENTAL INFORMATION ON BACK

† Include information for additional operators in REMARKS section. CONTRACTOR COPY - PRE-USE / RELEASE

OPTIONAL FORM 296 (REV. 2-2016)

7540-01-120-0607

50296-103

PREVIOUS EDITION NOT USABLE

 

Section IV - Transport and Support Vehicles

Motor vehicle parts and accessories must be in Safe Operating Condition At All Times, FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION (FMCSA) as prescribed by U.S. DEPARTMENT OF TRANSPORTATION FEDERAL HIGHWAY ADMINISTRATION PARTS 393 & 396, and NORTH AMERICAN UNIFORM OUT-OF-SERVICE CRITERIA, COMMERCIAL VEHICLE SAFETY ALLIANCE (CVSA).

REJECT IF: Parts and accessories covered in FMCSR part 393, 396 and/or CVSA North American Uniform Out-of- service Criteria are not in safe and proper operating conditions at all times. These include, but are not limited to the parts and accessories listed below.

2. Gauges and Lights (393.82, 393.11)

♦Speedometer inoperative.

♦All required lighting devices, relectors and electrical equipment must be properly positioned, colored and working.

3. Seat Belts (393.93)

♦Any driver or right outboard seat belt missing or inoperative.

4. Glass and Mirrors (393.60, 393.80)

♦Any discoloration not applied by the manufacturer for reduction of glare.

♦Any windshield crack over 1/4” wide.

♦Any crack less than 1/4” wide that intersects with any other crack.

♦Any damage 3/4” or greater in diameter.

♦Any 2 damaged areas closer than 3” to each other.

♦Any required mirror missing. One on each side , irmly attached to the outside of the vehicle, and so located as to relect to the driver a view of the highway to the rear along both sides of the vehicle.

♦Any required mirror broken.

5. Wipers and Horn (393.78, 393.81)

♦Wiper blade(s) fail to clean windshield within 1” of windshield sides.

♦Horn missing, inoperative or fails to give adequate/reliable warning signal.

10. Fuel System (393.65, 393.67)

♦Fuel tank not securely attached to vehicle by reason of loose, broken or missing mounting bolts or brackets.

♦Visible leak at any point.

♦Fuel tank cap missing.

20. Exhaust (393.83)

♦Any part of the exhaust system so located as would be likely to result in charring, burning, or damaging the wiring, fuel supply or any combustible part of the vehicle.

♦Bus exhaust leaks or discharge forward of the rearmost part of the bus in excess of 6" for Gasoline powered or 15" for other than Gasoline powered, or forward of any door or window designed to be opened on other than a Gasoline powered bus. (Exception: emergency exit).

♦Any leak at any point forward of or directly below the driver and/or sleeper compartment.

21. Frame (393.201)

♦Any cracked, broken, loose or sagging frame member.

♦Any loose or missing fasteners including those attaching engine, transmission, steering gear, suspension, body, and fifth wheel.

♦Any condition that causes the body or frame to contact the tire or wheel assemblies.

22. Tires and Wheels (393.75, 393.205)

♦Any body ply or belt material exposed through tread or sidewall.

♦Any tread or sidewall separation.

♦Any cut exposing ply or belt material.

♦Tread depths less than 4/32" on steering axle.

♦Less than 2/32" on any other axle.

♦Any bus with regrooved, recapped, or retreaded tires on the front wheels.

♦Any tire not properly inflated or any overloaded tire.

♦Any tire that comes in contact with any part of the vehicle.

♦Any tire marked "Not for Highway Use".

♦Wheels or rims shall not be cracked or broken.

♦Stud or bolt holes on the wheels shall not be elongated.

♦Nuts or bolts shall not be missing or loose.

14. Steering (393.209)

♦Steering wheel does not turn freely, has any spokes cracked through or is missing any parts.

♦Steering lash not within parameters, see chart in FMCSA 393.209.

♦Steering column is not secure.

♦Steering system; any U-joint worn, faulty or repaired by welding.

♦Steering gear box is loose, cracked or missing mounting bolts.

♦Pitman arm is loose, or has any welded repairs.

♦Power Steering; any component is inoperative. Any loose, broken or missing parts. Belts frayed, cracked or slipping.

♦Any fluid leaks, fluid reservoir not full.

15. Brakes (393.40-393.55)

♦Brake system has any deficiencies as described in FMCSA.

♦Brake system has any missing, loose, broken, out of adjustment or worn out components.

♦Brake system failure warning device missing, inoperative, or fails to give adequate warning.

♦Brake system has any air or fluid leaks.

18. Suspension Systems (393.207)

♦Any axle positioning part is cracked, broken, loose or missing. All axles must be in proper alignment.

♦Any leaf spring cracked, broken, missing or shifted out of position.

♦Adjustable axle assemblies with locking pins missing or not engaged.

24. Emergency Equipment (393.95)

♦Every power unit must be equipped with a fire extinguisher that is properly filled and readily accessible for use.

♦Spare fuses or other overload protective device.

♦Warning devices for stopped vehicles.

25. License (383.23, 391.41)

♦No person shall operate a commercial motor vehicle unless such person has passed written and driving tests which meet the Federal Standards for the commercial motor vehicle that person operates.

♦Persons shall not drive a commercial motor vehicle unless he/she is physically qualified to do so and has on his/her person the original, or a photographic copy, of a medical examiner's certificate that he/she is physically qualified.

IN ADDITION TO THE ABOVE:

Agency personnel reserve the right to reject any equipment due to any additional condition or combination of conditions that make the vehicle unsafe, unreliable, or may pose unreasonable damage to the environment, or will be unable to fully perform the duties for which the equipment has been hired.

The inspector shall inspect for compliance with the FMCSA, State and Local laws and regulations.

Therefore, the Inspector must ACCEPT or REJECT all equipment he/she inspects.

FINANCE COPY - RELEASE
(Describe all unsatisfactory items and identify by line number)
SEE SUPPLEMENTAL INFORMATION ON BACKSIDE OF CONTRACTOR COPY

VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST

GENERAL EQUIPMENT INFORMATION

1.

INCIDENT NAME/NO.

2. RESOURCE ORDER NO.

 

 

 

 

 

 

3.

CONTRACTOR NAME

 

 

 

 

 

 

 

 

 

4.

AGREEMENT NO.

 

5. EXPIRATION DATE

 

 

 

 

 

 

6.

MAKE/MODEL

7. EQUIPMENT TYPE

 

 

 

 

 

 

 

8.

VIN/SERIAL NO.

 

9. LICENSE NO./STATE

 

 

 

 

 

 

 

 

 

 

 

 

Section I—HEAVY EQUIPMENT

 

 

 

Acceptable

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

1. ROPS, roll-over protection system: Manufacturer-approved

 

 

 

system secured to mainframe of tractor. Must include

*

 

 

approved seat belts.

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

3.Battery: check for corrosion, loose terminals, and hold downs.

4.Engine running: check oil pressure, knocks and leaks.

5.

Sweeps, delectors, safety screensJODVV

*

6.

Steering components: tight, free of play.

*

7.

Brakes: damaged, worn or out of adjustment.

*

8. Exhaust system: equipped with a USFS-qualiied spark

*

 

arrester unless turbocharged.

 

 

 

 

 

9.

Fuel system: free of leaks and damage.

*

10.

Cooling system: full, free of leaks and damage.

*

11. Fan and fan belts: check for proper tension. No fraying/cracks.

 

 

 

 

12.

Engine support, equalizer bar, springs, main springs: check

*

 

shackle bolts, shifted spring leaf.

 

13.

Belly plate, radiator guards: securely mounted and free from

*

 

debris.

 

14.

Final drive, transmission and differential: check for dripping.

 

 

 

 

15.

Sprocket and idlers: crack in spokes, sharp sprocket teeth,

 

 

no welds.

 

 

 

 

16.

Tracks and rollers: no broken pads, loose rollers, broken

*

 

langes.*URXVHUKHLJKWPLQ

 

 

17.

Dozer and assembly: trunnion bolts missing, cracks.

*

18.Rear hitch (drawbar): serviceable, safe.

19.Body and cab condition: describe dents and damage.

20.Equipment cleanliness: all areas free of lammable materials, noxious weeds, and invasive species.

21.All hydraulic attachments: operate smoothly and all cylinders hold at extension; hose, lines, and pumps have no excessive wear and/or leaks.

22. Backup or travel alarm (minimum 87 dbl).

*

23. Oil level and condition: full and clean.

Section II—ATTACHMENTS/PUMP/CHAINSAW/OR

Acceptable

 

OTHER (Specify)

 

 

YES NO

 

1.No missing/broken components, no loose hardware.

2.Suficient luid levels (oil, coolant, etc.)

3.Cutting bar: straight, chain in good condition.

4.Cutting teeth: sharp, good repair.

5.Pump: builds pressure, no water or oil leaks.

6.Engine starts, idles, and shuts off with switch.

10. PRE-USE INSPECTION

 

 

 

Accepted

Rejected

MILES/HRS

 

 

 

DATE

 

TIME

 

Inspector’s printed name

 

 

 

Title

 

 

Inspector’s signature

 

 

 

 

 

 

 

Section III—LIABILITY

The purpose of this checklist is to document pre-existing vehicle/equipment condition and to determine suitability for incident use. I hereby acknowledge full responsibility and liability for the operation and mechanical condition of the vehicle/ equipment described herein.

Operator’s printed name

 

 

Title

 

 

Operator’s signature

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV—TRANSPORT OR SUPPORT VEHICLES

Acceptable

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

“DOT” or CVSA inspection in the last 12 months (if required). *

 

 

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

 

 

 

 

 

 

 

 

 

 

 

3.

Seat belts: operate properly for each seating position.

*

 

 

 

 

 

 

 

 

 

 

 

4.

Glass and mirrors, no cracks in vision.

*

 

 

 

 

 

 

 

 

 

 

 

5.

Wipers, washers, and horn operate properly.

*

 

 

6.Clutch pedal: proper adjustment (if applicable).

7.Cooling system: full, free of leaks and damage.

8.Fluid levels (e.g. oil) and condition: full and clean.

9.Battery: check for corrosion, loose terminals and hold downs.

10. Fuel system: free of leaks and damage.

*

11.Electrical system: alternator and starter work.

12.Engine running: check oil pressure, knocks, and leaks.

13.Transmission: check for leaks.

14.

Steering components: tight, free of play.

*

 

 

 

15.

Brakes: damaged, worn or out of adjustment.

*

16.4-Wheel drive: check transfer case, leaks (if applicable).

17.Drive line U-joints: check for looseness.

18.

Suspension systems: springs, shocks, other.

*

 

 

 

19.

Differential(s): check for leaks.

 

 

 

 

20.

Exhaust system: no leaks under cab or before turbo.

*

 

 

 

21.

Frame condition, body/bed properly attached.

*

 

 

 

22.

Tires/wheels (including spare and all changing equipment)

*

suficient load rating, tread depth, no major damage.

23.Body and interior condition: describe and locate damage on back of page 3, Section IV, item 23.

24. Emergency equipment required.

*

 

Fire extinguisher

 

Spare fuses

 

 

Relectors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25. Operator(s) properly licensed. †

Expiration Date

 

 

State

 

 

License No

 

 

 

 

 

 

 

 

Class

 

 

Endorsement

 

 

 

 

 

 

 

 

 

Med. Cert. Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. RELEASE

 

 

 

 

 

 

 

No Damage/No Claim

MILES/HRS

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

TIME

 

 

Operator’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Operator’s signature

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

Inspector’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Contractor ______________________________ Resource Order No. _____________

Section V—REMARKS

*Safety Item—Do not accept until brought into compliance.

†Include information for additional operators in REMARKS section. 7540-01-120-0607

PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 296 (REV. 2-2016) 50296-103

Section IV, Item 23 - Truck, Bus, Van, Pickup, Body Condition Inspection

Pre-Use Inspection

Release Inspection

Remarks

OPTIONAL FORM 296

INSPECTOR COPY - PRE-USE RELEASE
(Describe all unsatisfactory items and identify by line number)
SEE SUPPLEMENTAL INFORMATION ON BACKSIDE OF CONTRACTOR COPY

VEHICLE/HEAVY EQUIPMENT PRE-USE INSPECTION CHECKLIST

GENERAL EQUIPMENT INFORMATION

1.

INCIDENT NAME/NO.

2. RESOURCE ORDER NO.

 

 

 

 

 

 

3.

CONTRACTOR NAME

 

 

 

 

 

 

 

 

 

4.

AGREEMENT NO.

 

5. EXPIRATION DATE

 

 

 

 

 

 

6.

MAKE/MODEL

7. EQUIPMENT TYPE

 

 

 

 

 

 

 

8.

VIN/SERIAL NO.

 

9. LICENSE NO./STATE

 

 

 

 

 

 

 

 

 

 

 

 

Section I—HEAVY EQUIPMENT

 

 

 

Acceptable

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

 

 

1. ROPS, roll-over protection system: Manufacturer-approved

 

 

 

system secured to mainframe of tractor. Must include

*

 

 

approved seat belts.

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

3.Battery: check for corrosion, loose terminals, and hold downs.

4.Engine running: check oil pressure, knocks and leaks.

5.

Sweeps, delectors, safety screensJODVV

*

6.

Steering components: tight, free of play.

*

7.

Brakes: damaged, worn or out of adjustment.

*

8. Exhaust system: equipped with a USFS-qualiied spark

*

 

arrester unless turbocharged.

 

 

 

 

 

9.

Fuel system: free of leaks and damage.

*

10.

Cooling system: full, free of leaks and damage.

*

11. Fan and fan belts: check for proper tension. No fraying/cracks.

 

 

 

 

12.

Engine support, equalizer bar, springs, main springs: check

*

 

shackle bolts, shifted spring leaf.

 

13.

Belly plate, radiator guards: securely mounted and free from

*

 

debris.

 

14.

Final drive, transmission and differential: check for dripping.

 

 

 

 

15.

Sprocket and idlers: crack in spokes, sharp sprocket teeth,

 

 

no welds.

 

 

 

 

16.

Tracks and rollers: no broken pads, loose rollers, broken

*

 

langes.*URXVHUKHLJKWPLQ

 

 

17.

Dozer and assembly: trunnion bolts missing, cracks.

*

18.Rear hitch (drawbar): serviceable, safe.

19.Body and cab condition: describe dents and damage.

20.Equipment cleanliness: all areas free of lammable materials, noxious weeds, and invasive species.

21.All hydraulic attachments: operate smoothly and all cylinders hold at extension; hose, lines, and pumps have no excessive wear and/or leaks.

22. Backup or travel alarm (minimum 87 dbl).

*

23. Oil level and condition: full and clean.

Section II—ATTACHMENTS/PUMP/CHAINSAW/OR

Acceptable

 

OTHER (Specify)

 

 

YES NO

 

1.No missing/broken components, no loose hardware.

2.Suficient luid levels (oil, coolant, etc.)

3.Cutting bar: straight, chain in good condition.

4.Cutting teeth: sharp, good repair.

5.Pump: builds pressure, no water or oil leaks.

6.Engine starts, idles, and shuts off with switch.

10. PRE-USE INSPECTION

 

 

 

Accepted

Rejected

MILES/HRS

 

 

 

DATE

 

TIME

 

Inspector’s printed name

 

 

 

Title

 

 

Inspector’s signature

 

 

 

 

 

 

 

Section III—LIABILITY

The purpose of this checklist is to document pre-existing vehicle/equipment condition and to determine suitability for incident use. I hereby acknowledge full responsibility and liability for the operation and mechanical condition of the vehicle/ equipment described herein.

Operator’s printed name

 

 

Title

 

 

Operator’s signature

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section IV—TRANSPORT OR SUPPORT VEHICLES

Acceptable

 

 

YES NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

“DOT” or CVSA inspection in the last 12 months (if required). *

 

 

 

 

 

 

 

 

 

2.

Gauges and lights: mounted and function properly.

*

 

 

 

 

 

 

 

 

 

 

 

3.

Seat belts: operate properly for each seating position.

*

 

 

 

 

 

 

 

 

 

 

 

4.

Glass and mirrors, no cracks in vision.

*

 

 

 

 

 

 

 

 

 

 

 

5.

Wipers, washers, and horn operate properly.

*

 

 

6.Clutch pedal: proper adjustment (if applicable).

7.Cooling system: full, free of leaks and damage.

8.Fluid levels (e.g. oil) and condition: full and clean.

9.Battery: check for corrosion, loose terminals and hold downs.

10. Fuel system: free of leaks and damage.

*

11.Electrical system: alternator and starter work.

12.Engine running: check oil pressure, knocks, and leaks.

13.Transmission: check for leaks.

14.

Steering components: tight, free of play.

*

 

 

 

15.

Brakes: damaged, worn or out of adjustment.

*

16.4-Wheel drive: check transfer case, leaks (if applicable).

17.Drive line U-joints: check for looseness.

18.

Suspension systems: springs, shocks, other.

*

 

 

 

19.

Differential(s): check for leaks.

 

 

 

 

20.

Exhaust system: no leaks under cab or before turbo.

*

 

 

 

21.

Frame condition, body/bed properly attached.

*

 

 

 

22.

Tires/wheels (including spare and all changing equipment)

*

suficient load rating, tread depth, no major damage.

23.Body and interior condition: describe and locate damage on back of page 3, Section IV, item 23.

24. Emergency equipment required.

*

 

Fire extinguisher

 

Spare fuses

 

 

Relectors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25. Operator(s) properly licensed. †

Expiration Date

 

 

State

 

 

License No

 

 

 

 

 

 

 

 

Class

 

 

Endorsement

 

 

 

 

 

 

 

 

 

Med. Cert. Expiration Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. RELEASE

 

 

 

 

 

 

 

No Damage/No Claim

MILES/HRS

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

TIME

 

 

Operator’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Operator’s signature

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

Inspector’s printed name

 

 

 

 

 

 

 

 

 

 

Title

 

 

Contractor ______________________________ Resource Order No. _____________

Section V—REMARKS

*Safety Item—Do not accept until brought into compliance.

†Include information for additional operators in REMARKS section. 7540-01-120-0607

PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 296 (REV. 2-2016) 50296-103

Get 296 PDF Form

Form Characteristics

Fact Name Description
Form Title Vehicle/Heavy Equipment Pre-Use Inspection Checklist
Purpose This form documents the pre-existing condition of a vehicle or equipment and determines its suitability for use in an incident.
Governing Law This form is governed by Federal Motor Carrier Safety Administration (FMCSA) regulations and Commercial Vehicle Safety Alliance (CVSA) standards.
Sections Included The form consists of five sections: General Equipment Information, Heavy Equipment Inspection, Attachments/Pumps, Transport or Support Vehicle Inspection, and Remarks.
Inspection Frequency A DOT or CVSA inspection is required within the last 12 months for compliance.
Safety Items Certain items marked with an asterisk (*) are critical for safety and must be compliant before acceptance.
Formats Available This form is available in printed format and is specified as Optional Form 296 (REV. 2-2016).
Signature Requirement Both the inspector and operator must sign the form, acknowledging its content and responsibilities.

Guidelines on Utilizing 296

The following steps outline how to complete the 296 form, which is a Vehicle/Heavy Equipment Pre-Use Inspection Checklist. This process involves documenting critical details about the equipment, ensuring that all safety measures and operating conditions are met prior to its use.

  1. Gather the necessary equipment and personal information to complete the form, including the incident name, resource order number, contractor name, agreement number, expiration date, make/model, equipment type, VIN/serial number, and license number/state.
  2. Fill in the general equipment information at the top of the form.
  3. Move to Section I and evaluate each item listed under Heavy Equipment. Determine whether each item is acceptable by marking "YES" or "NO" where indicated.
  4. Pay particular attention to critical safety items, such as the roll-over protection system, brakes, and exhaust system. These should be marked "YES" only when they meet the specified criteria.
  5. For items that are marked "NO," briefly describe the condition in the remarks section provided.
  6. Proceed to Section II, which focuses on Attachments/Pump/Chainsaw or Other. Assess the condition of the components listed here and complete in the same manner.
  7. In Section III, fill out your printed name, title, and sign as the inspector. Record the date.
  8. Then, if applicable, complete Section IV regarding Transport or Support Vehicles, performing a similar review of the safety and operating conditions as done in Section I. Mark the items with "YES" or "NO." Document any issues in the remarks section if necessary.
  9. Finally, check Section V for any additional remarks regarding unsatisfactory items, ensuring all necessary information has been captured.

After completing the form, it should be submitted as per the local procedures. This documentation will ensure that the equipment is safe and compliant with regulations before use.

What You Should Know About This Form

What is the purpose of the 296 form?

The 296 form is designed to document the pre-use condition of vehicles and heavy equipment. It aims to ensure that equipment is suitable for safe operation before being used in any incidents or work. This form captures important details about equipment safety features, operational status, and compliance with safety regulations.

Who is responsible for filling out the 296 form?

The form must be completed by an inspector who evaluates the condition of the vehicle or equipment. Additionally, the operator of the equipment must also sign the form, acknowledging responsibility for its operational condition. Both roles are crucial in ensuring accountability and safety standards are met.

What information must be included in the General Equipment Information section?

This section requires details such as the incident name and number, resource order number, contractor name, agreement number, expiration date, make/model of the equipment, equipment type, VIN or serial number, and license information. Failing to provide this information may lead to delays or complications in equipment use.

What are some key safety checks performed on heavy equipment?

Key checks include ensuring the roll-over protection system is secure, verifying that gauges and lights function properly, and inspecting the brakes, steering components, and fuel system for leaks or damage. The inspection also covers the hydraulic attachments and overall cleanliness of the equipment to avoid fire hazards or contamination.

What should an operator do if the equipment does not pass the inspection?

If the equipment does not meet the necessary safety standards, it should not be accepted for use. The inspector will identify unsatisfactory items on the form, and these must be addressed and brought into compliance before re-evaluation. The form contains specific areas for remarks related to these issues.

How often should the 296 form be completed?

The pre-use inspection should be completed every time the equipment is prepared for operation, especially if it has been idle or after any repairs or maintenance. Additionally, for transport or support vehicles, compliance with DOT or CVSA inspection requirements is necessary within the last 12 months.

What happens if an inspector finds a safety item unfit for service?

If a safety issue is identified, the inspector must reject the equipment until it is corrected. Items marked with an asterisk (*) in the checklist indicate critical safety concerns that must be resolved before the equipment can be deemed safe for operational use. This is a vital step in mitigating risks associated with equipment malfunction during operations.

Common mistakes

When filling out Form 296, mistakes can easily happen. One common error is not providing sufficient detail for the equipment being inspected. For instance, if you leave fields like "Contractor Name" or "VIN/Serial Number" blank or incomplete, it may lead to confusion down the line. Documentation accuracy is key. Each piece of equipment needs a unique identifier to avoid potential liabilities.

Another frequent mistake occurs when checking off the acceptable items in the checklist. Some individuals may rush through the "Yes" or "No" selections, possibly overlooking a crucial safety item. For example, if the roll-over protection system (ROPS) isn’t assessed properly, it could put users in harm’s way. Ensuring that each item is carefully evaluated and accurately recorded is essential for ensuring equipment safety.

Additionally, people often neglect to sign the form. Both the inspector and the operator must provide their signatures to validate the inspection. Failing to do this can render the inspection invalid and weaken the credibility of the document. Always take a moment to ensure that both parties have signed before submitting the form.

Lastly, the remarks section is sometimes underutilized or filled with vague comments. This section is important for documenting any unsatisfactory items and providing clear insights into the equipment's condition. Leaving out specific details can cause misunderstandings about what issues need attention. Make sure to identify unsatisfactory or problematic items clearly by line number, ensuring the next person reviewing the form understands what needs to be addressed.

Documents used along the form

When dealing with the Vehicle/Heavy Equipment Pre-Use Inspection Checklist (Form 296), it is important to be aware of other documents that often accompany it during the equipment inspection and operational verification process. Each of these forms serves as a vital part of ensuring safety and compliance in the field, providing a comprehensive view of the condition of the vehicles and equipment.

  • Equipment Maintenance Log: This document records all maintenance and repairs performed on the equipment. It details dates, descriptions of work done, and responsible personnel, helping to establish a history of compliance and upkeep.
  • Driver Qualification File: This file contains information regarding the qualifications and credentials of the operators. It typically includes copies of driving licenses, medical certifications, and training records, ensuring that only qualified individuals operate the machinery.
  • Incident Report Form: Should any accidents or incidents occur during equipment operation, this form is used to document the details. It includes information such as the date, location, individuals involved, and a description of the event, providing a thorough account for review.
  • Safety Meeting Minutes: Records from safety meetings where crew members discuss safety protocols, equipment handling procedures, and incident reports. These minutes serve as a reminder of the importance of safety and the collective knowledge shared within the team.

By ensuring that these forms are completed and accompanying the Vehicle/Heavy Equipment Pre-Use Inspection Checklist, individuals can enhance safety protocols and maintain equipment in optimal working condition. This holistic approach not only fosters a safer work environment but also reinforces a culture of accountability and diligence.

Similar forms

  • DOT Vehicle Inspection Report: Similar to the 296 form, this report documents the condition and safety of a vehicle before it is used on public roads. Both forms focus on essential components like brakes, lights, and seat belts, ensuring the vehicle meets safety standards.
  • Maintenance Inspection Checklist: Like the 296 form, this checklist is used for regular inspections of equipment. It typically covers the operational status and safety conditions of machinery, including parts that must be reliable for safe operation.
  • Pre-Trip Inspection Form: This form, used by commercial drivers, resembles the 296 form as it requires a thorough examination of a vehicle's operational functionalities before a journey. It similarly highlights components such as engine status and fluid levels.
  • Heavy Equipment Operator's Daily Log: This document ensures that heavy machinery operators maintain a record of their equipment’s performance and safety checks. Parallel to the 296 form, it emphasizes pre-use inspections and operational readiness.
  • Safety Inspection Report: Similar to the 296 form, this report addresses safety checks on various equipment types, including vehicles. Both emphasize the importance of ensuring all equipment is safe before use.
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Dos and Don'ts

  • Do: Carefully review each section of the form before filling it out. Ensure that you understand the requirements and what each question is asking for.
  • Do: Make sure all information is accurate and complete. Avoid leaving any fields blank that require an answer.
  • Do: Document any deficiencies or items not meeting requirements clearly in the remarks section. Specify line numbers for clarity.
  • Do: Sign and date the form where required to acknowledge that you have reviewed the information and accept responsibility.
  • Don't: Rush through the inspection or the completion of the form. Take your time to ensure that everything is correct.
  • Don't: Skip or overlook any of the safety items, especially those marked with an asterisk, as these are critical for compliance.
  • Don't: Use abbreviations or unclear wording when describing damages or conditions; clarity is essential.
  • Don't: Forget to check expiration dates on licenses and certifications. Ensure they are current before completing the form.

Misconceptions

Misconception 1: The 296 Form is only for large equipment and heavy machinery.

This form is not exclusive to heavy machinery. It also applies to transport vehicles like trucks and vans. All vehicles used in incidents must undergo a pre-use inspection, regardless of size. This ensures that any vehicle can safely perform its required tasks.

Misconception 2: Filling out the 296 Form is optional.

The 296 Form is a critical document. It is mandatory to complete it to ensure that all vehicles and equipment are fit for operation. Neglecting this step exposes operators to risks and can lead to serious consequences, especially in emergency situations.

Misconception 3: If a vehicle passes the inspection once, it doesn’t need to be inspected again.

Each time a vehicle is used for an incident, it must be re-inspected. Conditions can change after every use, making it necessary to verify the vehicle's integrity again. Regular inspections help to catch potential issues before they become serious problems.

Misconception 4: Inspectors can accept a vehicle as long as some items are in good condition.

Inspectors can only accept vehicles that meet all safety requirements outlined in the 296 Form. If any critical safety items fail, the vehicle must be either repaired or rejected until it meets compliance standards. This vital practice upholds safety and reliability on the job.

Key takeaways

Here are key takeaways about filling out and using the 296 form for vehicle and heavy equipment pre-use inspections:

  • Thorough Documentation: Ensure all sections are completed accurately. Include incident name, contractor details, and equipment specifics.
  • Inspection Items: Conduct a thorough inspection of each item listed in sections I and II. This includes safety systems, operational functionality, and conditions of parts.
  • Safety Compliance: Identify safety items marked with an asterisk. These must meet safety standards before equipment can be accepted.
  • Signature Necessity: Require signatures from both the inspector and the operator at the time of the inspection. This confirms accountability for the equipment’s condition.
  • Release Clause: Understand the implications of the release section. If no damage is found, the operator must sign the release statement.
  • Remarks Section: Use the remarks area to note any defects, unsatisfactory items, or compliance issues. Clear explanations will facilitate necessary repairs.
  • Regular Review: Conduct periodic reviews of the completed forms to ensure compliance with operational standards and improve future inspections.
  • Maintain Records: Keep copies of inspection forms for accountability and future reference. These documents can be crucial for audits or assessments.

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