This inspection form is to be used in conjunction with Optional Form 296

ENGINE INSPECTION FORM PASS ___ FAIL ___

Company Name: Date of Inspection: Page 1 of 3

Vehicle Id.#: (VIN#) Odometer Reading:

NWCG Type Engine (3-6): Tank Capacity (gallons)
License #: State:
Make: Model: Year:
All Wheel Drive Yes No
Markings Posted on Vehicle (annotate actual postings) Yes No
Company Name:
Unit ID #:
DOT #:
Vehicle Licensing Satisfactory?
Yes No
Vehicle meets licensing requirements, current registration
Current DOT or CVSA inspection
Vehicle Weight
Manufacturers Gross Vehicle Weight:
Manufacturers Front Axle Rating:
Manufacturers Rear Axle Rating:
Certified Front Axle, loaded weight:
Certified Rear Axle, loaded weight:
Certified Weight Ticket of loaded vehicle:
Minimum Engine Inventory Yes No Qty
1 - Live Hose Reel w/ minimum of 100’ of 1” hose non-collapsible 3/4”
inside Diameter
1 ½” Hose (see table for min. quantity)
1” Hose (see table for min. quantity)
¾” Hose (see table for min. quantity)
2 – Nozzles, comb fog/straight stream, 1 ½” NH Female
2– Nozzle, comb fog/straight stream, 1” NPSH Female
2 – Nozzle, Adjustable ¾” Garden Hose
20’ Suction hose with strainer or screened foot valve
3 – Shovels, size “0”
3 – Pulaskis
1- Forestry, Fire Hose Clamp
4 – Spanner wrenches, combination, 2 ea 1” & 1 ½”
1- Double Male 1 ½” NH
1- Double Female 1 ½” NH
1 – Double Male 1” NPSH
1 – Double Female 1” NPSH
2 – Gated Wyes, 1 ½” NH
2 – Gated Wyes 1” NPSH
1 – Gated Wye ¾” Garden Hose
4 – Reducers, 1 ½” NH Female to 1” NPSH Male
1 – Reducer 1” NPSH to ¾” Garden Hose
2 – Adapters 1 ½” NH Female to 1 ½” NPSH Male
2 – Adapters 1 ½” NPSH Female to 1 ½” NH Male
1 – Mop-Up Wand ¾” Receptor w/ ¾” Nozzle Tip
5 – Inline Ball Valves ¾”
Engine Inspection Form (continued) Page 2 of 3
Company Name: Date of Inspection: Engine #
Minimum Engine Inventory – continued Yes No Qty
2 – Backpack pumps
1 Gallon Container for drinking water
1 – First Aid Kit (5 person)
3 – Headlamps w/Batteries and Hardhat Attachment
10 – Fusee’s (fire starter)
3 – Mill Bastard Files
3 – Line Gear (Day Pack)
Specific Requirements Yes No Qty
1 ea. – Saw with fuel (3.0 cubic in. min w/18” bar, chaps, hearing protection
gas/oil, and accessories (OSHA Approved Fuel Containers)
2 ea. – Programmable Radio’s at least one must be hand held with 2 additional
batteries & Programming Cable (Narrow Band Compliant)
Additional Vehicle Safety Items
Reflective Triangles, bi-directional, set of 3
Fire Extinguisher, 1 rated at 10 B:C or better
Chock Blocks 2
Seat Belts for all Passengers
Back up Alarm & back up lights
Personal Protective Equipment Yes No Qty
Fire Shelter Nomex shirt/pants Hardhat Gloves Boots
Pump Accessories (If Pump Powered by Auxiliary Engine) Yes No Qty
Wrench, Adjustable 10”
Wrench, Spark Plug (Unless adjustable wrench is suitable)
1 Pliers (Slip Joint)
2 Qts. Crankcase Oil
1 Screwdriver (Standard Blade)
1 Screwdriver (Phillips)
1 Spare Starter Rope (If Required)
1 Grease Gun with Grease
Spark Plugs (Sufficient to replace all plugs on auxiliary pump)
Compressed Air Foam System (CAFS) Yes No
Actual Compressor Rating (cubic feet per minute)
Foam Proportioner System (check one)
Fixed Manual Adjustable Automatic Adjustable None
Amount of foam carried on engine in gallons: (min. 5 gal.)
Water Tank Firmly Attached to Frame or structurally sound flat bed Yes No
1 ea 1 ½” discharge valve full flow, rapid shut off
Pump Type (check one) Auxiliary PTO
Actual Pump PSI _____________ CHECK ONE: Acceptable______Good_________Excellent_______
Yes No
Draft from 10 feet vertical through suction hose with foot valve
Pump and roll capability
Fuel to operate pump (min. 12 hours) in DOT approved container
Vehicle Tires
Tire load ratings in accordance with vehicle GVWR
All season mud and snow tread with minimum 4/32” front 2/32” rear tread
Vehicles with 4-wheel drive must have mud and snow tread on all wheels
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”
ENGINE INSPECTION FORM (continued) Page 3 of 3
Company Name: Date of Inspection: Engine #

Vehicle Condition
Glass (chips/cracks)

Body Condition (dents/scratches)

Name of Contractor (type or print) Signature of Contractor Date

Name of Inspector (type or print) Signature of Inspector Date

Inspectors’ Agency Inspectors’ Phone #

Remarks: ( document all items that fail inspection)

Pressure and Flow Testing of Pumps – Refer to Exhibit J

Type 3 engines
Pressure with .716 diameter sharp edged orifice installed
 250 to 312 psi is a rating of “Acceptable”
 312.5 to 374 psi is a rating of “Good”
 375 psi or more is a rating of “Excellent”
Type 4, 5, 6 engines
Pressure measured with a .520 diameter sharp edged orifice installed
 100 psi to 124 psi is a rating of “Acceptable”
 125 psi to 149 psi is a rating of “Good”
 150 psi or more is a rating of “Excellent”

COMPONENTS WILDLAND ENGINES – TABLE M.1

3 4 5 6
PUMP RATING
Minimum flow (GPM) 150 50 50 50
@ Rated pressure (PSI) 250 100 100 100
Tank Capacity (GAL)
MIN 500 750 400 150
MAX 1500 1500 749 399
Hose (feet)
1 1/2 inch 1000 300 300 300
1 inch 500 300 300 300
¾ inch Garden Hose 300 300 300 300
Live Hose Reel ¾” ID 100 100 100 100
Pump and Roll Yes Yes Yes Yes
Foam Proportioner System Yes No No No
Maximum GVWR (lbs.) - - 26,000 19,500
Personnel Required 3 3 3 3
 CHAINSAW AND CHAINSAW KIT INSPECTION CHECKLIST
(Wildland Engines Only)

(Minimum Engine Power required is 3.0 cubic inches)

MANUFACTURER______________________

Model Number:______________Serial Number:________________________

CHAINSAW: YES NO
No Visible parts broken

All visible nuts and bolts tight

Oil in chain oil reservoir

Proper Exhaust system and spark arrester
Started and checked the engine, idles evenly, runs smoothly,
satisfactory power; on/off kill switch works

Guide Bar is at the minimum of 18 inches and not bent or

damaged
Pull rope functions properly
Chain brake works properly

CHAINSAW KIT:
1 CHAINSAW KIT BAG OR BOX TO STORE
COMPLEMENT
1 Combination Bar/ Sparkplug wrench
1 SPARE SPARK PLUG to fit saw
1 PINT OF SPARE ENGINE OIL FOR ENGINE FUEL
MIXTURE
1 PAIR OF WRAP AROUND LEG SAFETY CHAPS – OSHA
APPROVED
1 EXTRA CHAIN TO FIT SAW-BAR COMBO
1 CHAIN FILE
1 FELLING AXE
1 FELLING WEDGE
1 - OSHA APPROVED FUEL CONTAINER TO HOLD
CHAINSAW FUEL AND GUIDE BAR OIL PROPERLY
SECURED ON VEHICLE
2 SETS EAR PLUGS

Contractor is required to have both the chainsaw and the OSHA approved containers full of proper fuel
mixture and oil at the time of the pre-award inspection.