EQUIPMENT CONDITION REPORT

VEHICLE NO._______________     OPERATORS NAME___________________________       DATE__________   

TYPE OF EQUIPMENT:       Loader____   Trencher_____    Boom Truck____  Loader____      Other________________

       v  =OK_____         X=Needs repair

I have inspected each item above and found each item in proper working order, or I have noted the defects above.

Signed______________________________     

I certify That  ___   Items noted do not affect the safe operation of the equipment

                       ___   Repairs noted have been corrected

Mechanics Signature_________________________________      Date:_____________

Vehicle Repair Order#_________________________-      Date:__________________