Aerial Lift Inspection

• Conducted on:

  Date

• Building Name:

• Operator(s):

  Select

• Other:

Vehicle Identification

• Type of Lift (i.e. 65ft Boom)

• Identification Number:

Operating Controls

• Emergency Stop & Brakes

  Safe

  At Risk

  N/A

• Base Operation Controls

  Safe

  At Risk

  N/A

• Basket Operation Controls

  Safe

  At Risk

  N/A

• Foot Controls (if applicable)

  Safe

  At Risk

  N/A

• Safety Signs (Readable)

  Safe

  At Risk

  N/A

Boom

• Hydraulic Leaks

  Safe

  At Risk

  N/A

• Extension Chain & Pivot Pins

  Safe

  At Risk

  N/A

• Electrical Lines

  Safe

  At Risk

  N/A

• Basket Cage & Gate

  Safe

  At Risk

  N/A

• Anchorage Points

  Safe

  At Risk

  N/A

Base (Visual)

• Broken, Cracked, or Loose Parts

  Safe

  At Risk

  N/A

• Leaks

  Safe

  At Risk

  N/A

• Electrical

  Safe

  At Risk

  N/A

• Tires & Outriggers

  Safe

  At Risk

  N/A

• Back Up Alarm (if applicable) & Manual

  Safe

  At Risk

  N/A

Engine Compartment (Visual)

• Oil Level

  Safe

  At Risk

  N/A

• Fuel Level

  Safe

  At Risk

  N/A

• Belt, Hose & Motor Condition

  Safe

  At Risk

  N/A

• Battery & Electrical

  Safe

  At Risk

  N/A

• Additional comments or observations

  Yes

  No

  N/A

• Additional Notes:

Notes

• Note:

• I hereby certify that all information is accurate and that an actual inspection was conducted as per company policy.

• Inspector's Printed Name & Signature

  Sign