Please fill in a valid value for all required fields
Please ensure all values are in a proper format.
Are you sure you want to leave this form and resume later?
Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.
Save and Resume Later
Save and get link
You must upload one of the following file types for the selected field:
There was an error displaying the form. Please copy and paste the embed code again.
Apply Discount
You saved
with code
Submit Form
Submitting
Validating
There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.
Please check the field:
Fields
Date of Inspection
*
https://millerpipeline.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
Foreman's Name
*
First Name
*
Last Name
*
Unit or Serial #
*
Is this a rental unit?
*
Yes
No
Hour Meter Reading
Check the appropriate boxes below
ALL items below are in good, working condition; No issues to report or address.
General
General
Okay
Needs attention
Not Applicable
Fire extinguisher 10BC
General: Fire extinguisher 10BC (Okay)
Fire extinguisher 10BC (Needs attention)
Fire extinguisher 10BC (Not Applicable)
Glass- No visual Distortion
Glass- No visual Distortion (Okay)
Glass- No visual Distortion (Needs attention)
Glass- No visual Distortion (Not Applicable)
Backup alarm
Backup alarm (Okay)
Backup alarm (Needs attention)
Backup alarm (Not Applicable)
Horn
Horn (Okay)
Horn (Needs attention)
Horn (Not Applicable)
Access- Skid resistant
Access- Skid resistant (Okay)
Access- Skid resistant (Needs attention)
Access- Skid resistant (Not Applicable)
Mirrors
Mirrors (Okay)
Mirrors (Needs attention)
Mirrors (Not Applicable)
Wipers
Wipers (Okay)
Wipers (Needs attention)
Wipers (Not Applicable)
Lights
Lights (Okay)
Lights (Needs attention)
Lights (Not Applicable)
Defrost
Defrost (Okay)
Defrost (Needs attention)
Defrost (Not Applicable)
Brakes
Brakes (Okay)
Brakes (Needs attention)
Brakes (Not Applicable)
Steering
Steering (Okay)
Steering (Needs attention)
Steering (Not Applicable)
Engine
Engine (Okay)
Engine (Needs attention)
Engine (Not Applicable)
Shifting- Transmission
Shifting- Transmission (Okay)
Shifting- Transmission (Needs attention)
Shifting- Transmission (Not Applicable)
Mainframe Damage
Mainframe Damage (Okay)
Mainframe Damage (Needs attention)
Mainframe Damage (Not Applicable)
Final drive planetary leaks
Final drive planetary leaks (Okay)
Final drive planetary leaks (Needs attention)
Final drive planetary leaks (Not Applicable)
Swing Mechanism
Swing Mechanism (Okay)
Swing Mechanism (Needs attention)
Swing Mechanism (Not Applicable)
Hydraulic
Hydraulic
Okay
Needs attention
Not Applicable
Pump
Hydraulic: Pump (Okay)
Pump (Needs attention)
Pump (Not Applicable)
Cylinder
Cylinder (Okay)
Cylinder (Needs attention)
Cylinder (Not Applicable)
Hoses
Hoses (Okay)
Hoses (Needs attention)
Hoses (Not Applicable)
Leaks
Leaks (Okay)
Leaks (Needs attention)
Leaks (Not Applicable)
Controls
Controls
Okay
Needs attention
Not Applicable
Operation
Controls: Operation (Okay)
Operation (Needs attention)
Operation (Not Applicable)
Adjustment
Adjustment (Okay)
Adjustment (Needs attention)
Adjustment (Not Applicable)
Check for wear
Check for wear (Okay)
Check for wear (Needs attention)
Check for wear (Not Applicable)
Boom and stick
Boom and stick
Okay
Needs attention
Not Applicable
Visual check
Boom and stick: Visual check (Okay)
Visual check (Needs attention)
Visual check (Not Applicable)
Bent
Bent (Okay)
Bent (Needs attention)
Bent (Not Applicable)
Wear
Wear (Okay)
Wear (Needs attention)
Wear (Not Applicable)
Cracks
Cracks (Okay)
Cracks (Needs attention)
Cracks (Not Applicable)
Pins tight
Pins tight (Okay)
Pins tight (Needs attention)
Pins tight (Not Applicable)
Bushings
Bushings (Okay)
Bushings (Needs attention)
Bushings (Not Applicable)
Paint
Paint (Okay)
Paint (Needs attention)
Paint (Not Applicable)
Bucket hook
Bucket hook
Okay
Needs attention
Not Applicable
Closed hook
Bucket hook: Closed hook (Okay)
Closed hook (Needs attention)
Closed hook (Not Applicable)
Screw pin shackle
Screw pin shackle (Okay)
Screw pin shackle (Needs attention)
Screw pin shackle (Not Applicable)
Less than 15% spread
Less than 15% spread (Okay)
Less than 15% spread (Needs attention)
Less than 15% spread (Not Applicable)
Less than 10 degrees twist
Less than 10 degrees twist (Okay)
Less than 10 degrees twist (Needs attention)
Less than 10 degrees twist (Not Applicable)
Any cracks?
Any cracks? (Okay)
Any cracks? (Needs attention)
Any cracks? (Not Applicable)
Teeth, sidecutters
Teeth, sidecutters (Okay)
Teeth, sidecutters (Needs attention)
Teeth, sidecutters (Not Applicable)
Tires and Wheels
Tires and Wheels
Okay
Needs attention
Not Applicable
Wheel Lugs
Tires and Wheels: Wheel Lugs (Okay)
Wheel Lugs (Needs attention)
Wheel Lugs (Not Applicable)
Tire Pressure
Tire Pressure (Okay)
Tire Pressure (Needs attention)
Tire Pressure (Not Applicable)
Tire Wear/Damage
Tire Wear/Damage (Okay)
Tire Wear/Damage (Needs attention)
Tire Wear/Damage (Not Applicable)
Bearings
Bearings (Okay)
Bearings (Needs attention)
Bearings (Not Applicable)
Undercarriage
Undercarriage
Okay
Needs attention
Not Applicable
Track pads
Undercarriage: Track pads (Okay)
Track pads (Needs attention)
Track pads (Not Applicable)
Rollers (wear & leaks)
Rollers (wear & leaks) (Okay)
Rollers (wear & leaks) (Needs attention)
Rollers (wear & leaks) (Not Applicable)
Idlers
Idlers (Okay)
Idlers (Needs attention)
Idlers (Not Applicable)
Sprockets
Sprockets (Okay)
Sprockets (Needs attention)
Sprockets (Not Applicable)
Track Adjusters
Track Adjusters (Okay)
Track Adjusters (Needs attention)
Track Adjusters (Not Applicable)
Documentation
Documentation
Okay
Needs attention
Not Applicable
Load charts in place
Documentation: Load charts in place (Okay)
Load charts in place (Needs attention)
Load charts in place (Not Applicable)
Manual in machine
Manual in machine (Okay)
Manual in machine (Needs attention)
Manual in machine (Not Applicable)
Hazard warning signs
Hazard warning signs (Okay)
Hazard warning signs (Needs attention)
Hazard warning signs (Not Applicable)
Swing radius danger signs
Swing radius danger signs (Okay)
Swing radius danger signs (Needs attention)
Swing radius danger signs (Not Applicable)
Hand Signal Chart
Hand Signal Chart (Okay)
Hand Signal Chart (Needs attention)
Hand Signal Chart (Not Applicable)
Gauges
Gauges
Okay
Needs attention
Not Applicable
Temperature
Gauges: Temperature (Okay)
Temperature (Needs attention)
Temperature (Not Applicable)
Oil Pressure
Oil Pressure (Okay)
Oil Pressure (Needs attention)
Oil Pressure (Not Applicable)
Amp meter
Amp meter (Okay)
Amp meter (Needs attention)
Amp meter (Not Applicable)
Hydraulic Oil Temp
Hydraulic Oil Temp (Okay)
Hydraulic Oil Temp (Needs attention)
Hydraulic Oil Temp (Not Applicable)
Other
Other (Okay)
Other (Needs attention)
Other (Not Applicable)
Additional Comments
Inspector Name
*
First Name
*
Last Name
*
Previous
←
Next
→
Enter your save and resume password
Cancel
Confirm
