SCOFIELD'S TOWING INC.

43 South Skiview Drive

Beloit, Wisconsin 53511
608-921-0726

Driver's Daily Safety Maintence Sheet, Log Sheet, Mileage Sheet

And Hours Of Duty Sheet
COMPLETION OF THIS REPORT IS REQUIRED BY FEDERAL MOTOR CARRIER SAFETY REGULATIONS SECTION 396.11 AND 396.13
Absolutely no people are allowed on tow truck bed or vehicle in tow.
Driver (initials) / Date Time in am / pm
Company / Scofield's Towing INC Time out am / pm
Make / Ford / Year - 1995 End Mileage
Model / Superduty Rollback Start Mileage
License / Wisconsin / GD 33109 Total Mileage
Vin # 1FDLF47F1SEA43518 Tire info. LT 235 / 85 R 16 120/1160 M+S Load Range E80 PSI.
Check the following items each day when you start to work and again when you finish work
When you start work, put a mark in the proper box like this / ( if there is no work, do not fill out sheet )
When you finish work, put a mark in the proper box like this \
No driver is to work over 10 hrs. straight without a min. of 10 hrs.off duty / Office hours are 9 am. To 7 pm.
If more than 10 hrs. are needed, call office for instructions or call Tony or Ron @ 608-921-0726
Fill fuel tanks at end of your shift (turn in receipts to office).
OK Needs corrective action. OK Needs corrective action.
Motor oil level (manual) Winch line (Visual / badly frayed?)
Motor coolant (visual) Winch mounting bolts ( visual / all there?)
Brake fluid level (visual) Hydraulic rams, hoses, valves (visual / leaks)
Headlamps (visual) Fire extinguisher (full?) (visual)
Tail lamps (visual) Exhaust sys.(visual)(Listen for excessive noise)
Turn signals (visual) Hyd. fluid level (bottom of screen min)(visual)
Four way warning lamps (visual) Unusual tire wear (visual)
Towing lamps (on top)(visual) Low tire pressure (visual )
Work lamps (visual) Frame (visiblecracks) (visual)
Oil pressure (visual) Mud flaps (visual)
Flashlight (in cab) (visual) Fuel tank caps (visual)
Windshield wipers (visual) Horn (push horn)
Back window (visual) Brakes (Check pedal w / motor running)
Mirrors (visual) Steering (with motor running / tight?)
Windshield wipers (visual) Parking brake(push E-brake down and move truck against it)
Defroster / Fan (manual) Speedometer / tach (visual)
Fuel in tanks ? ( check gage) Necessary tools to do job ? (visual)
Comments or corrective action needed or done:

Turn completed sheet into office at the end of your day, along with other reciepts, & work orders.
Office will review comments or corrective action that is suggested, and if necessary, take the necessary steps to
correct the situation. Repair invoice #__________________
Attach copy of Repair Invoice to this sheet
Repairs completed by____________________________________________Date_________________________
Driver informed of Results. Date___________________Driver Signature________________________________________
SCOFIELD'S TOWING INC.
43 South Skiview Drive
Beloit, Wisconsin 53511
608-921-0726