Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Type of Equipment

  • What type of lift will be used?

  • Are the wheels in good shape?

  • Is the operators manual on the machine?

  • Does the main ground controls work properly?

  • Does the man basket controls work properly?

  • Does the deadman switch work?

  • Do the brakes work?

  • Do the warning lights, warning audio device and horn work properly?

  • Are there any oil leaks ?

  • Are there any cracks in the welds or steel?

  • Are all the guards in place?

  • Date of last Maintanance performed

  • Photos of equipment

  • Equipment photo
  • Photo

Fuel

  • What is the fuel source?

  • Do the batteries have signs of corrosion?

  • Are the battery cables in good shape?

  • Are the batteries leaking.

  • Photos of equipment
  • Add media

  • How is the fuel level?

  • Are the fuel lines in good condition?

  • Are the battery cables in good shape?

  • Do the batteries have signs of corrosion?

  • Are the batteries leaking.

  • Photos of equipment
  • Add media

  • How is the fuel level?

  • Are the fuel lines in good condition?

  • Do the batteries have signs of corrosion?

  • Are the battery cables in good shape?

  • Are the batteries leaking.

  • Photos of equipment
  • Add media

  • How is the fuel level?

  • Are the fuel lines in good condition?

  • Does the propane tank have corrosion?

  • Has the propane tank expired?

  • Do the batteries have signs of corrosion?

  • Are the battery cables in good shape?

  • Are the batteries leaking.

  • Photos of equipment
  • Add media

  • Are there other fuel souces?

General

  • Is there an operators manual present?

  • Is a fire extinguisher present?

  • What is the weight of the equipment?

  • Is the platform clear of debris?

  • Are all side rail pins in place?

  • Does the lift work on auxiliary power?

Hydraulics

  • Are the hydraulic fluid levels okay?

  • Are any of the hydraulic cylinders leaking?

  • Does the hydraulic pump show signs of deterioration or damage?

Fall Protection systems to be used

  • Identify the fall protection systems to be used at the work site to protect the workers from fall hazards ( ie, travel restraint, fall arrest, safety net, control zone, etc.)

Fall Hazards

  • Identify all existing and potential fall hazards associated with work site

Anchors to be used during the work

  • Identify the anchors, both engineered and improvised that workers are to use

Procedures

  • Identify the procedures to assemble, inspect, use, maintain and dismantle the fall protection systems identified above

Rescue plan

  • Describe the procedures that will be followed if a worker falls and needs to be rescued

Worker sign off

  • Worker acknowledgement of fall arrest plan and fall arrest equipment inspection.

  • Worker
  • No physical damage to harness webbing? (cuts, burns, frying, chemical)

  • Stitching in good condition?

  • Buckles in Good condition and operating properly?

  • Chest strap in good condition?

  • Carabiner in good condition and operating properly?

  • Lanyard, no damage to (cuts, fraying, burns, chemicals, non factory markings)

  • Lanyard shock absorber in place and not damaged?

  • Harness and lanyard stored properly when not in use?

  • Photo of harness and lanyard

  • Signature worker using the harness and lanyard.

  • Certificate of Proficiency.

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.