Dozer/Tractor Plow Module



Location:

|      |Date: |      | |

|Respondent: |      |Reviewed By: |      |

|Dozer/Tractor MFR: |      |ID No: |      |

|Mileage/Hours: |      |License No.: |      |

|Transport type |      |ID No.: |      |

|MFR Year: |      |Mileage/Hours: |      |

|Key Code: E = Exceeds Standard M = Meets Standard NI = Needs Improvement NR = Not Reviewed |

|Description |Code |Remarks |

|TRACTOR AND TRAILER |

| |Tractor/trailer bed meets DOT standards, including: |      |      |

| |Hydraulic lift | | |

| | | | |

| |Track guides | | |

| | | | |

| |Airlines | | |

| | | | |

| |Toolboxes | | |

| | | | |

| |Outriggers | | |

| | | | |

| |Ramps | | |

| | | | |

| |Tie-downs | | |

| | | | |

| |GVW | | |

| | | | |

| |Back up alarm | | |

| | | | |

| |Tires | | |

| |ID numbers are displayed front/rear. |      |      |

| |Annual Heavy Equipment Maintenance/Inspection completed. |      |      |

| |Wide load signs/flashers are available. |      |      |

|DOZER |

| |Lights are installed and working properly. |      |      |

| |Rollover protection meets manufacturer specifications. |      |      |

| |Operator fire shelter is available. |      |      |

| |Dozer is equipped with a spark arrester system. |      |      |

| |Dozer is equipped with a back up alarm. |      |      |

| |Screens are installed for timber operation. |      |      |

| |Dozer/Tractor plow has been trained on accident/injury |      |      |

| |notification procedures. | | |

| |Vehicle Accident Report | | |

| | | | |

| |SAFENET | | |

| | | | |

| |CA-1/CA-16 | | |

| | | | |

| |Safety Management Information System (SMIS) | | |

| |Dozer/Tractor plow regularly participates in a documented |      |      |

| |tailgate safety session. | | |

| |Unit Safety Plan is available and can be readily accessed. |      |      |

| |Dozer/Tractor has Job Hazard Analysis completed for all |      |      |

| |suppression work practices/projects that have potential | | |

| |hazards. | | |

| |Dozer/Tractor plow has Risk Assessment completed for all |      |      |

| |non-suppression work practices/projects that have potential | | |

| |hazards. | | |

| |Radio operations meet requirements: |      |      |

| |Minimum number of radios | | |

| | | | |

| |Knowledge of radio programming | | |

| |(Narrow/Wide Band/Frequencies) | | |

| | | | |

| |Understand frequency authorization and use issues | | |

| | | | |

| |Facility radio and speaker system | | |

| | | | |

| |Approved local radio frequencies are posted | | |

| |Dozer/Tractor plow supervisors are familiar with |      |      |

| |administrative issues and prepare and secure documents as per | | |

| |agency standards: | | |

| |T&As | | |

| | | | |

| |Crew time reports | | |

| | | | |

| |Fire time reports | | |

| | | | |

| |Per Diem forms | | |

| | | | |

| |Accident reports | | |

| | | | |

| |Credit card purchases and records | | |

| | | | |

| |Fleet purchasing cards | | |

| |Dozer/Tractor plow members meet the agency qualifications |      |      |

| |required of their positions. | | |

| |Status (filled/vacant) of supervisory positions within the |      |      |

| |approved Organizational Chart. | | |

| |Supervisors are familiar with air cargo transport limitations |      |      |

| |and requirements including: | | |

| |Purging of gas receptacles | | |

| | | | |

| |Air transport manifesting | | |

| | | | |

| |Weight limitations | | |

| | | | |

| |Safe packaging procedures for specialized equipment | | |

| | | | |

| |Local security requirements and procedures | | |

|INCIDENT QUALIFICATIONS AND CERTIFICATION CONSIDERATIONS |

| |The Incident Qualifications and Certification System is used |      |      |

| |to produce Red Card qualifications. | | |

| |Dozer/Tractor plow members have current Red Cards. |      |      |

| |Dozer/Tractor plow members have a documentation file for |      |      |

| |current season training, certification, and experience | | |

| |(Hardcopy or Electronic). | | |

| |Dozer/Tractor plow members have a hard-copy file for past |      |      |

| |season fire training, fire experience, task books, performance| | |

| |evaluations and physical fitness. | | |

| |Each module member who drives a government vehicle has a |      |      |

| |current Application for U.S. Government Vehicle Operator’s | | |

| |Identification Card (Form DI-131) and Physical Fitness for | | |

| |Motor Vehicle Operator (Form OF-345), or local equivalent on | | |

| |file. | | |

| |Dozer/Tractor plow has access to training materials and |      |      |

| |equipment. | | |

| |Dozer/Tractor plow members are current in annual firefighter |      |      |

| |safety refresher training. | | |

| |Dozer/Tractor plow members have taskbooks initiated |      |      |

| |appropriate to their training needs. (NWCG 310-1) | | |

| |Dozer/Tractor plow members have documentation of currency with|      |      |

| |the agency medical standards. | | |

| |Employees are being provided mandatory safety and health |      |      |

| |training for the following programs: | | |

| |Annual Fireline Safety Refresher | | |

| |Defensive Driving (if applicable) | | |

| |First Aid | | |

| |CPR | | |

| |Blood Borne Pathogens (BBP) | | |

| |New Employee Orientation | | |

| |Hazard Communications | | |

| |JHA/RA | | |

| |Fire tool use and maintenance | | |

| |Any specific training identified by JHA | | |

| | | | |

| |Hazardous Materials First Responder Awareness. | | |

| | | | |

| |Chainsaw (S-212) for chainsaw operators | | |

| |Dozer/Tractor plow members have attended employee orientation.|      |      |

| |Orientation included all items found on the orientation | | |

| |checklist at : | | |

| |ntc.leadership/orientation.form_checklist_I.htm | | |

| |Each module member has reviewed and signed an Employee |      |      |

| |Performance Appraisal Plan (EPAP) for the current season. | | |

| |Per agency standards module members participate in an |      |      |

| |established physical fitness program. | | |

| |Dozer/Tractor plow is aware of and meets agency mobilization |      |      |

| |standards, including: | | |

| |Mobilization and get-away time frames | | |

| | | | |

| |Driver duty limitations | | |

| | | | |

| |Work/rest requirements | | |

| |Dozer/Tractor plow members possess commercial drivers’ license|      |      |

| |where appropriate. | | |

|FACILITIES |

| |Formal safety inspections of physical facilities are made by a|      |      |

| |qualified inspector at least once each fiscal year per BLM | | |

| |Manual 1112-1 and Manual Handbook 1112-2. | | |

| |Computer/fax/telephone equipment meets the needs of the |      |      |

| |module(s). | | |

| |Facility has security for: |      |      |

| |Personnel records (privacy act notice OS-76 Item 43 schedule) | | |

| | | | |

| |Government equipment | | |

| | | | |

| |Personal equipment | | |

| |Safety Equipment and Signing includes: (OSHA 29CFR1910) |      |      |

| |Fire Extinguisher | | |

| | | | |

| |Smoke alarms | | |

| | | | |

| |First aid kits | | |

| |Storage of flammables/hazardous materials meets standards. |      |      |

| |(OSHA 29CFR1910) | | |

| |Bulletin board includes appropriate postings: |      |      |

| |Unit and module organization charts. | | |

| | | | |

| |Emergency Notification Procedures | | |

| | | | |

| |10 Standard Fire Orders | | |

| | | | |

| |18 Watch Out Situations | | |

| | | | |

| |LCES | | |

| | | | |

| |Facility fire plan | | |

| | | | |

| |Fire danger information | | |

| | | | |

| |Fire weather information | | |

| | | | |

| |Smoking policy | | |

| | | | |

| |Sexual harassment policy/EEO counselors | | |

| | | | |

| |Department of Labor required information. | | |

| |dol/osbp/public/sbrefa/poster/main.htm | | |

| |Employee right-to-know information/Material Safety Data Sheet |      |      |

| |(MSDS) is posted. | | |

|CACHE |

| |Inventory and use records are available and current. |      |      |

| |Inventories are posted, dated, signed. |      |      |

| |Cache is secure. |      |      |

| |Tools meet maintenance standards. (Fire Equipment and Storage |      |      |

| |and Refurbishing Standards NFES 2249) | | |

| |Portable fire extinguishers are provided in adequate numbers, |      |      |

| |serviced annually, mounted in readily accessible locations, | | |

| |and marked with a readily visible sign (in accordance with | | |

| |29CFR157). | | |

|VEHICLE |

| |Preventive maintenance checks are documented and current. |      |      |

| |Annual Gross Vehicle Weight (GVW) slip from a certified scale |      |      |

| |is documented in logbook and meets vehicle specifications. | | |

| |References/paperwork available include: |      |      |

| |Accident report forms | | |

| | | | |

| |Communications plan | | |

| | | | |

| |Posted frequencies | | |

| | | | |

| |Inventory (specific to compartment/location) | | |

| | | | |

| |Use record current | | |

| | | | |

| |Preventive maintenance records | | |

| | | | |

| |Personnel accident/injury forms | | |

| | | | |

| |Unit maps | | |

| | | | |

| |Current North American Emergency Response Guide Book | | |

| | | | |

| |Current credit card | | |

|SAFETY AND MEDICAL |

| |Non-skid surface per (OSHA 29CFR1910) |      |      |

| |Portable fire extinguishers are provided in adequate numbers, |      |      |

| |serviced annually, mounted in readily accessible locations, | | |

| |and marked with a readily visible sign (in accordance with | | |

| |29CFR157). | | |

| |Hazard reflectors/flares. (BLM 1112-2) |      |      |

| |First aid/trauma kit is available and appropriate size; |      |      |

| |location is identified in a highly visible manner. (BLM | | |

| |1112-2) | | |

|TOOLS/EQUIPMENT |

| |Jack (serviceable for GVW). (BLM 1112-2) |      |      |

| |Lug wrench. (BLM 1112-2) |      |      |

For the National Preparedness Review you will need to have the following items available for review.

|Checklist |Documentation |

|Item # | |

|3 |Annual Maintenance Records |

|12 |Documentation of Tailgate safety sessions |

|13 |Unit Safety Plan |

|14 |Job Hazard Analysis’s (JHA’s) |

|15 |Risk Assessment Forms |

|21-24 |Documents referenced |

|26-32 |Documents referenced |

|36 |CDL license for drivers. (where applicable) |

|49-51 |Vehicle log book/maintenance records/annual weight slips |

| | |

| |Interagency Standards for Fire and Fire Aviation Operations |

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