Information
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Equipment Type or Number .
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Project Name/Number
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Conducted on
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Prepared by
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Location
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Was a Daily Inspection Done?
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Are workers using proper personal fall protection equipment?
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Are workers remaining on the platform at all times?
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Is the gate/chain closed when occupied?
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Is the aerial/scissor lift on level ground per manufacturers recommendations?
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Is the operator trained properly?
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Are tools and materials secured from displacement from the lift?
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Is the lifting capacity visible and appropriate for the task to be completed?
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Are lanyards and/or retractable lifelines attached to proper anchorage points?
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Was a pre-start inspection performed?
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Are all cracks, dents, or damage in the welds or structural components of the aerial/scissor lift been repaired to manufacturers specifications?
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Are all safety warning devices functioning properly?
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Have all controls been tested for proper operation prior to any elevated use?
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Is there proper clearance above, below and on all sides of the lift?
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Are power lines located at a safe distance from the aerial/scissor lift?
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Operator Signature
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Auditor Signature
