Information

  • Equipment Type or Number .

  • Project Name/Number

  • Conducted on

  • Prepared by

  • Location
  • Was a Daily Inspection Done?

  • Are workers using proper personal fall protection equipment?

  • Are workers remaining on the platform at all times?

  • Is the gate/chain closed when occupied?

  • Is the aerial/scissor lift on level ground per manufacturers recommendations?

  • Is the operator trained properly?

  • Are tools and materials secured from displacement from the lift?

  • Is the lifting capacity visible and appropriate for the task to be completed?

  • Are lanyards and/or retractable lifelines attached to proper anchorage points?

  • Was a pre-start inspection performed?

  • Are all cracks, dents, or damage in the welds or structural components of the aerial/scissor lift been repaired to manufacturers specifications?

  • Are all safety warning devices functioning properly?

  • Have all controls been tested for proper operation prior to any elevated use?

  • Is there proper clearance above, below and on all sides of the lift?

  • Are power lines located at a safe distance from the aerial/scissor lift?

  • Operator Signature

  • Auditor Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.