Customer Details

Customer Name:

Initial Horizon Contact:

Customer contact requesting survey:

Date survey was requested:
Date survey completed:

Site Contact:

Was site contact present:

Address of site:
Machine Requirements

What is the required platform height (m):

Is horizontal reach required:

What is the horizontal reach (m):

Does the machine need to be articulated:

At what height is the knuckle required (m):

What is machine required for:

Site Restrictions

Is there any height restrictions:

What are the height restrictions (m):

Is there a width restriction:

What are the width restrictions (m):

Is there any length restrictions:

What is the length restriction (m):

Is there any weight restrictions:

What is the weight restriction:

Is there any obstructions:

What are the obstructions:

What are the ground conditions/gradients:

Delivery Restrictions (Truck Access / Timed Access):

Delivery restriction details:

Working on a road / pavement

Type of road (30mph/private):

Permit Required:

Additional Survey Required (Traffic Management/specific machine specialist):

Notes of 'working on road' restrictions / requirements / comments / observations:

Machine Selection
Date Machine Required:

1st choice machine:

Alternative Machine:

Site Pictures:
Sketch of site / building:

Surveyor Name:

Surveyor Signature:
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.