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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