Tractor Safety Inspection Form

Owners Name___________________________________ Tractor Make_______________

Address_______________________________________ Tractor Name_____________

City/Sate/Zip___________________________________ Phone #__________________

Engine Make ___________________ Engine Serial Number______________________

Tractor ID # __________________ Tractor Inspection #(office only) ______________

Class:                    Off Lawn         Diesel         Stock Altered         Sport Stock         Pro Stock         Open/Unlimited         Mini Rod

              ITEMS TO BE INSPECTED                       NA               PASS              FAIL

Frame/sheet metal modification
A. Frame                                                                          ______         ______         ______
B. Sheet Metal Modification Except Exhaust Pipe  ______         ______         ______

Safety Equipment
A. Kill Switch                                                                   ______         ______         ______
B. Fuel Shut Off – Electric/Manual                              ______         ______         ______
C. Secure Seat With 3 Inch Back                                  ______         ______         ______
D. Fire Equipment                                                           ______         ______         ______

Shielding
A. Spark Plug Blowout Protection                                ______         _______         _______
B. 360 Degrees – 1/8 Inch Thick
B.   1. Clutch                                                                      ______         ______         ______
B.   2. Engine Flywheel
B .     2 A. Solid Steel or Billet Aluminum/No Welding_____         ______         ______
B .     2 B. Points Cover                                                     ______         ______         ______
B.      2 C. Vertical Exhaust – Min 12 Inch From Port ______         ______         ______
B.   3. U-Joints                                                                    ______         ______         ______
B.   4. Vibration Dampener                                              ______         ______         ______
B.   5. All Rotating Parts – Belts & Chains, Etc.            ______         ______         ______

Wheelie Bars
A. Min 5 Inches Behind Rear Face of Rear Tires        ______         ______         ______
B. Max 5 Inches Off Ground. Measured To Center    ______         ______         ______
Point of Wheel or Rear Edge of Skid Plate

Brakes: Must Be Able to Lock Both Rear Wheels     ______         ______         ______

Deadman Throttle: Mandatory All Classes Ex OL  ______        ______         ______

Inspector Comments/Notes: ______________________________________________

Inspectors Signature________________________________ Date ________________