**[2007 ENGINE PRE-USE INSPECTION FORM]{.underline} PASS \_\_\_ FAIL
\_\_\_**

(To be used in conjunction with OF-296)

<table>
<colgroup>
<col style="width: 37%" />
<col style="width: 12%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 10%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="4"><strong><u>Company Name: Equipment #</u></strong></td>
<td colspan="9"><strong><u>Date of Inspection:</u></strong> Page 1 of
2</td>
</tr>
<tr class="even">
<td colspan="2"><strong><u>Vehicle Id.#: (VIN#)</u></strong></td>
<td colspan="11"><strong><u>Odometer Reading:</u></strong></td>
</tr>
<tr class="odd">
<td colspan="3">NWCG Type Engine (3-6):</td>
<td colspan="10">Tank Capacity (gallons)</td>
</tr>
<tr class="even">
<td colspan="2">License #:</td>
<td colspan="11">State:</td>
</tr>
<tr class="odd">
<td>Make:</td>
<td colspan="5">Model:</td>
<td colspan="7">Year:</td>
</tr>
<tr class="even">
<td colspan="13">DOT #:</td>
</tr>
<tr class="odd">
<td colspan="6" rowspan="2"><strong><u>Vehicle
Licensing</u></strong></td>
<td colspan="7"><strong><u>Satisfactory?</u></strong></td>
</tr>
<tr class="even">
<td colspan="3"><strong>Yes</strong></td>
<td colspan="4"><strong>No</strong></td>
</tr>
<tr class="odd">
<td colspan="6">Vehicle meets licensing requirements, current
registration</td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="6"><strong><u>Minimum Engine Inventory</u></strong></td>
<td colspan="2"><strong>Yes</strong></td>
<td colspan="3"><strong>No</strong></td>
<td colspan="2"><strong>Qty</strong></td>
</tr>
<tr class="odd">
<td colspan="6">1 - Live Hose Reel w/ minimum of 100’ of 1” hose
non-collapsible 3/4” inside Diameter</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">1 ½” Hose (see table for min. quantity)</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1” Hose (see table for min. quantity)</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">¾” Hose (see table for min. quantity)</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">2 – Nozzles, comb fog/straight stream, 1 1/2” NPSH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">2– Nozzle, comb fog/straight stream, 1” NH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">2 – Nozzle, Adjustable ¾” Garden Hose</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">20’ Suction hose w/strainer or screened (3/32”) foot
valve</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">3 – Shovels, size “0”</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">3 – Pulaskis</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1- Forestry, Fire Hose Clamp</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">4 – Spanner wrenches, combination, 2 ea 1” &amp; 1
½”</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1- Double Male 1 ½” NH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">1- Double Female 1 ½” NH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1 – Double Male 1” NPSH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">1 – Double Female 1” NPSH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">2 – Gated Wyes, 1-1/2” NH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">2 – Gated Wyes 1” NH</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1 – Gated Wye ¾” Garden Hose</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">4 – Reducers, 1-1/2” NH Female to 1” NPSH Male</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1 – Reducer 1” NPSH to ¾ Garden Hose</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">2 – Adapters 1 ½” NH Female to 1/1/2 NPSH Male</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">2 – Adapters 1 ½” NPSH Female to 1 ½” NH Male</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">1 – Mop-Up Wand ¾” Receptor w/ ¾” Nozzle Tip</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">5 – Inline Ball Valves ¾”</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">2 – Backpack pumps</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">1 Gallon Container for drinking water</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">1 – First Aid Kit (5 person)</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">3 – Headlamps w/Batteries and Hardhat Attachment</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6">10 – Fusee’s (fire starter)</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="6">3 – Mill Bastard Files</td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="6"><strong><u>Specific Requirements</u></strong></td>
<td colspan="2"><strong>Yes</strong></td>
<td colspan="4"><strong>No</strong></td>
<td><strong>Qty</strong></td>
</tr>
<tr class="odd">
<td colspan="6">1 ea. – Saw with fuel (3.0 cubic in. min w/18” bar,
chaps, hearing protection gas/oil, and accessories (OSHA Approved Fuel
Containers)</td>
<td colspan="2"></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="6">2 ea. – Programmable Radio’s at least one must be hand
held with 2 additional batteries &amp; Programming Cable (Narrow Band
Compliant)</td>
<td colspan="2"></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="6"><strong><u>Additional Vehicle Safety
Items</u></strong></td>
<td colspan="2"></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="6">Reflective Triangles, bi-directional, set of 3</td>
<td colspan="2"></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="6">Fire Extinguisher, 1 rated at 10 B:C or better</td>
<td colspan="2"></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="6">Chock Blocks 2</td>
<td colspan="2"></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="7"><strong><u>Company Name Equipment #</u></strong></td>
<td colspan="6"><strong>Date</strong> 1 of 2</td>
</tr>
<tr class="even">
<td colspan="6">Seat Belts for all Passengers</td>
<td colspan="4"><strong>Yes</strong></td>
<td colspan="3"><strong>No</strong></td>
</tr>
<tr class="odd">
<td colspan="6">Back up Alarm &amp; back up lights</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="6"><strong><u>Personal Protective Equipment for All
Crewmembers</u></strong></td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6"><u><strong>Pump</strong> <strong>Accessories
</strong></u>(If Pump Powered by Auxiliary Engine)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="6">Wrench, Adjustable 10”</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6">Wrench, Spark Plug (Unless adjustable wrench is
suitable)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="6">1 Pliers (Slip Joint)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6">2 Qts. Crankcase Oil</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="6">1 Screwdriver (Standard Blade)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6">1 Screwdriver (Phillips)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="6">1 Spare Starter Rope (If Required)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6">1 Grease Gun w/Grease</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="6">Spark Plugs (Sufficient to replace all plugs on
auxiliary pump)</td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="6"><strong><u>Compressed Air Foam System
(CAFS)</u></strong></td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="13">Amount of foam carried on engine in gallons: (min. 5
gal.)</td>
</tr>
<tr class="odd">
<td colspan="5"><strong>Water Tank Firmly Attached to Frame or
structurally sound flat bed</strong></td>
<td colspan="5"><strong>Yes</strong></td>
<td colspan="3"><strong>No</strong></td>
</tr>
<tr class="even">
<td colspan="5">1 ea 1 ½” discharge valve full flow, rapid shut off</td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="5"><strong><u>Vehicle Tires</u></strong></td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="5">Tire load ratings in accordance with vehicle GVWR</td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="5">All season mud and snow tread with minimum 4/32” front
2/32” rear tread</td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="5">Vehicles with 4-wheel drive must have mud and snow tread
on all wheels</td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="5">Full size spare tire and wheel with changing equipment
that shall fit any position or a spare tire for front and rear axle. Min
tread 4/32”</td>
<td colspan="5"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="13" rowspan="2"><strong><u>Vehicle Condition</u></strong>
Glass (chips/cracks)</td>
</tr>
<tr class="odd">
</tr>
<tr class="even">
<td colspan="13"><strong><u>Body Condition</u></strong>
(dents/scratches)</td>
</tr>
<tr class="odd">
<td colspan="13"><strong><u>Name of Contractor</u> (type or print)
<u>Signature of Contractor</u> <u>Date</u></strong></td>
</tr>
<tr class="even">
<td colspan="13"><strong><u>Name of Inspector (type or print)</u>
<u>Signature of Inspector</u> <u>Date</u></strong></td>
</tr>
<tr class="odd">
<td colspan="13"><p><strong><u>Inspectors’ Agency</u> <u>Inspectors’
Phone #</u></strong></p>
<p><strong>Remarks: ( document all items that fail
inspection)</strong></p></td>
</tr>
<tr class="even">
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="13"></td>
</tr>
</tbody>
</table>