Form 296 – Fill Out and Use This PDF

Form 296 is a tax form. It's used to calculate the amount of your salary that goes into taxes and how much you will receive from your employer in regards to taxes withheld.

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Form 296 PDF Details

Form 296 is a tax form used to report and pay withheld federal income taxes. The form must be filed by employers who withhold income tax from employee wages, and includes the total amount of withheld tax liability for the year. Form 296 must be submitted by January 31st each year, regardless of whether any taxes were withheld. Late filings may result in penalties and interest charges. If you're an employer who withholds income tax from employee wages, it's important to understand how to fill out Form 296 correctly. This form reports the total amount of withheld tax liability for the year, so it's critical that all information is accurate. Failure to submit Form 296 on time may result in penalties and interest charges.

The table has got specifics of the form 296. This article can provide details about the form's length, completion time, and the blanks you are required to fill.

Question	Answer
Form Name	Form 296
Form Length	6 pages
Fillable?	Yes
Fillable fields	592
Avg. time to fill out	39 min 59 sec
Other names	daily equipment inspection checklist template excel, daily equipment inspection checklist, equipment inspection log, equipment inspection checklist template excel

12

Form Preview 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
					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.	*
	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	*
	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
								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

<![endif]>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
					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.	*
	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	*
	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
								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

<![endif]>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
					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.	*
	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	*
	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
								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

<![endif]>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
					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.	*
	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	*
	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
								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

<![endif]>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

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The fillable equipment inspection checklist filling in process is simple. Our editor enables you to work with any PDF form.

Step 1: On this website page, choose the orange "Get form now" button.

Step 2: After you have entered the editing page fillable equipment inspection checklist, you'll be able to discover all of the options available for the document within the upper menu.

Feel free to type in the following details to create the fill, able equipment inspection checklist PDF:

equipment checklist template fields to complete

You should enter the data within the box Fuel, system, free, of, leaks, and, damage shackle, bolts, shifted, spring, leaf debris, no, welds Rear, hitch, draw, bar, serviceable, safe Backup, or, travel, alarm, minimum, d, bl Oil, level, and, condition, full, and, clean Section, II, ATTACHMENTS, PUMP, CHAINSAW, OR OTHER, Specify Acceptable, YES, NO Fuel, system, free, of, leaks, and, damage Transmission, check, for, leaks Steering, components, tight, free, of, play and Brakes, damaged, worn, or, out, of, adjustment

part 2 to filling out equipment checklist template

Note all particulars you may need within the section Cutting, teeth, sharp, good, repair Pump, builds, pressure, no, water, or, oil, leaks Endorsement, Med, Cert, Expiration, Date RELEASE, MILES, HRS DATE, Operators, printed, name Operators, signature Inspectors, printed, name No, Damage, No, Claim TIME, Title, Date, and Title.

stage 3 to entering details in equipment checklist template

Indicate the rights and responsibilities of the sides in the part GENERAL, EQUIPMENT, INFORMATION PRE, USE, INSPECTION INCIDENT, NAME, NO RESOURCE, ORDER, NO Accepted, Rejected, CONTRACTOR, NAME AGREEMENT, NO EXPIRATION, DATE MAKE, MODEL EQUIPMENT, TYPE V, IN, SERIAL, NO LICENSE, NO, STATE MILES, HRS and DATE.

equipment checklist template GENERALEQUIPMENTINFORMATION, PREUSEINSPECTION, INCIDENTNAMENO, RESOURCEORDERNO, Accepted, Rejected, CONTRACTORNAME, AGREEMENTNO, EXPIRATIONDATE, MAKEMODEL, EQUIPMENTTYPE, VINSERIALNO, LICENSENOSTATE, MILESHRS, and DATE fields to fill out

Finalize by taking a look at the next sections and filling them out as needed: shackle, bolts, shifted, spring, leaf debris, no, welds Rear, hitch, draw, bar, serviceable, safe Backup, or, travel, alarm, minimum, d, bl Oil, level, and, condition, full, and, clean Section, II, ATTACHMENTS, PUMP, CHAINSAW, OR OTHER, Specify Acceptable, YES, NO Fuel, system, free, of, leaks, and, damage Transmission, check, for, leaks Steering, components, tight, free, of, play Brakes, damaged, worn, or, out, of, adjustment and Drive, line, U, joints, check, for, looseness

Filling in equipment checklist template part 5

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