Agrodrain: Lifting Checklist.

• Prepared by

• Site

This Lifting checklist will be review for the periodic examination of powered lift trucks to confirm workers safety and load-handling capability.

• Project / Site

• Job Number

• Time and date of lift

  Date

• Supervisor's full name

• Operator's full name

Pre-Lift Checks

• Has a pre-lift meeting taken place?

  Yes

  No

  N/A

• Has the Supervisor(s) assessed lifting methods and confirmed appropriate piece of equipment to be used for the operation?

  Yes

  No

  N/A

• Has the Supervisor(s) inspected and passed all lifting devices and equipment to be used for the operation?

  Yes

  No

  N/A

• Has the load been assessed to ensure that the capability of the lifting equipment was not exceeded?

  Yes

  No

  N/A

• Have proper communication methods such as eye contact, hand signals, etc. between workers and operators been discussed

  Yes

  No

  N/A

• Have equipment swing/rotation zones been discussed and workers advised ?

  Yes

  No

  N/A

• Do the ground conditions appear to be acceptable for the lifting equipment?

  Yes

  No

  N/A

• Has a designated spotter been assigned for this lift?

  Yes

  No

  N/A

• Full name of Spotter

Sign Off

• Follow up

• Attendance

• The above is a true and correct reflection of checks that occurred before this lift occurred.

• Signature & Full Name of Site Foreman/Supervisor

  Sign

• Yes

  No

  N/A

• Add signature

  Sign