Customer Inspector Date

Machine Identification
Manufacturer Name Machine Name
Model Type
Serial Number Machine Weight
Machine Working Hours Year of Production
Note:

Undercarriage Data
Track Frame Configuration
Track Shoes Width
Track Shoe Type Single Grouser Double Grouser Triple Grouser Flat Shoe Rubber Pad Other
Track Guards Standard Full Length Forestry Other
Track Tension
Undercarriage Working Hours Track Groups Track Rollers Carrier Rollers Idlers Sprockets

Describe how machine operates and machine duty cycle in detail:

Rating of Soil Terrain Type

Application Operation Attachments
Characteristics High Moderate Low Even
Mining Levelling Blade Abrasiveness Uneven
Quarry Digging Ripper Impact Uphill & Downhill
Construction Pulling Shovel Packing Sidehill
Forestry Loading Winch Proper use Convex
Agriculture Demolition Hammer Maintenance Concave
Other Other Other Other Other

Single & Double Flange Track Rollers Tread Wear

RH Side P/Ns LH Side P/Ns
Int. Tread Ext. Tread °C Int. Tread Ext. Tread °C
1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

6 6 6 6

7 7 7 7

8 8 8 8

9 9 9 9

Correct Bolts Torque

Leaking

Turn Free

RH Side LH Side
Average wear of track rollers (%)
 Carrier Rollers Tread Wear
RH Side Roller P/N LH Side Roller P/N
Int. Tread Ext. Tread °C Int. Tread Ext. Tread °C
1 1 1 1

2 2 2 2

Correct Bolts Torque

Leaking

Turn Free

RH Side LH Side
Average wear of carrier rollers (%)

Front & Rear Idler Tread Wear

RH Side Idler P/N LH Side Idler P/N
Int. Tread Ext. Tread °C Int. Tread Ext. Tread °C
Front Front Front Front

Rear Rear Rear Rear

Correct Bolts Torque

Leaking

Turn Free

RH Side LH Side
Average wear of idler (%)

Track Group Wear

RH Side Track Group P/N LH Side Track Group P/N

Grouser Grouser Bushing
Forging code 4 Pitch Length Link Height Bushing Diam. Forging code 4 Pitch Length Link Height
Height Height Diam.

Leaking Joint Leaking Joint

Chipping on Chipping on
Link Link
Bent Shoe Bent Shoe
ML 1 2 3 4 5 6 7 ML 1 2 3 4 5 6 7

8 9 10 11 12 13 14 15 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 16 17 18 19 20 21 22 23

Track Pin End Track Pin End

Temperature 24 25 26 27 28 29 30 31
Temperature 24 25 26 27 28 29 30 31

32 33 34 35 36 37 38 39 32 33 34 35 36 37 38 39

40 41 42 43 44 45 46 47 40 41 42 43 44 45 46 47

RH Side LH Side
4 Pitch Grouser 4 Pitch Grouser Bushing
Average wear of track chain (%) Length
Link Height
Height
Bushing Diam.
Length
Link Height
Height Diam.