Black Box Group - MEWP Pre-Use inspection checklist

• Site
  Address
• Location
  Address

• Conducted on

  Date

• Prepared by

• Machine ref number

Documentation

• 1. Statutory examination / periodic inspection in date

  Yes

  No

  N/A

• 2. Manufacturers operator manual with the machine

  Yes

  No

  N/A

• 3. Rescue plan in place and name of nominated ground rescue person identified

  Yes

  No

  N/A

Wheels / Tyres

• 4. No Missing, loose or damaged nuts and retainers

  Yes

  No

  N/A

• 5. Tyre pressure (pneumatic, foam filled or solid)

  Yes

  No

  N/A

• 6. Condition (no cuts, splits, exposed braiding, damaged rims)

  Yes

  No

  N/A

Engine / Power Source

• 7. Fluid Levels (engine oil, coolant, fuel)

  Yes

  No

  N/A

• 8. No Fluid leakage on ground around engine

  Yes

  No

  N/A

• 9. Battery (electrolyte, connections, terminals, security and charging plug condition)

  Yes

  No

  N/A

Hydraulics

• 10. Hydraulic fluid level

  Yes

  No

  N/A

• 11. No leaks (hoses, pipe connections, rams, cylinders)

  Yes

  No

  N/A

Hoses and Cables

• 12. Security and conditions (no cuts, chaffing or bulges)

  Yes

  No

  N/A

• 13. Power track cable trays (free from damage and debris)

  Yes

  No

  N/A

Outriggers, Stabilisers

• 14. General Condition (pins, restrainer, footplate)

  Yes

  No

  N/A

• 15. Spreader plates (present, condition, secure for travel)

  Yes

  No

  N/A

• 16. Interlocks (functioning, engaged)

  Yes

  No

  N/A

Chassis, Boom and Scissor Pack

• 17. General condition (no damage, misalignment, corrosion)

  Yes

  No

  N/A

• 18. No cracks in weld

  Yes

  No

  N/A

• 19. Pins, retainers and chains (good condition, secure)

  Yes

  No

  N/A

• 20. Canopies, Guards, Engine covers (security and condition)

  Yes

  No

  N/A

Platform or Cage

• 21. Steps for access/egress secure (undamaged, clear of debris)

  Yes

  No

  N/A

• 22. Entrance gate, guard rails and retaining pins

  Yes

  No

  N/A

• 23. Harness / Lanyard anchorage points

  Yes

  No

  N/A

• 24. Clear of Rubbish, debris and obstructions

  Yes

  No

  N/A

• 25. Secondary guarding

  Yes

  No

  N/A

Decals and Signage

• 26. ID / Compliance plate, safety, warning and information decals (all present and legible)

  Yes

  No

  N/A

• 27. Controls (identification decals, directional arrows clearly marked)

  Yes

  No

  N/A

• 28. Platform loads (SWL, Max. Wind speed, Max. Number of persons clearly marked)

  Yes

  No

  N/A

Using Ground (G) and Platform (P) controls

• 29. Security device (power isolator, keypad, smart card)

  Yes

  No

  N/A

• 30. Function enable works correctly (ignition key, foot switch, hold to run device)

  Yes

  No

  N/A

• 31. Emergency stops and emergency / auxiliary lowering system are fully functional.

  Yes

  No

  N/A

• 32. All switches, function controls (move freely, return to neutral, operate as expected)

  Yes

  No

  N/A

• 33. Elevating Functions ( raise, lower, slew, tele-out, tele-in)

  Yes

  No

  N/A

• 34. Travel functions (forward, reverse, steer, brakes)

  Yes

  No

  N/A

• 35. Elevated drive speed activates when platform is raised (reduced or prevented)

  Yes

  No

  N/A

• 36. Lights, beacons and warning devices

  Yes

  No

  N/A

• 37. Audible alarms (tilt, descent and travel)

  Yes

  No

  N/A

• 38. Interlock, limit switches (e.g. descent, SWL, outreach, rotation)

  Yes

  No

  N/A

• 39. Pothole protection device (fully deploys and retracts)

  Yes

  No

  N/A

• 40. Oscillating axle locks and extending axles operate correctly

  Yes

  No

  N/A

• 41. Accessories, power to platform, extending decks

  Yes

  No

  N/A

• 42. Jacks-legs, stabilizers, outriggers, leveling devices

  Yes

  No

  N/A

• 43. Secondary guarding (function, operation, reset)

  Yes

  No

  N/A

• ALL FAULTS OR DEFECTS (*) TO BE REPORTED IMMEDIATELY TO YOUR SUPERVISOR IS THERE ANY FAULTS OR DEFECTS TO REPORT?

  Yes

  No

  N/A

• Who have you notified of the fault or defect

  Yes

  No

  N/A

• Can the fault or defect be detailed

• Can a photo be provided of the fault or defect

  Media

• ONLY PERSONS WHO ARE TRAINED AND AUTHORISED BY THEIR EMPLOYER SHOULD OPERATE THIS EQUIPMENT, IS THIS UNDERSTOOD?

  Yes

  No

  N/A

• OPERATOR #1 NAME

• OPERATOR #1 PAL CARD NUMBER

• OPERATOR #2 NAME

• OPERATOR #2 PAL CARD NUMBER

• OPERATOR #3 NAME

• OPERATOR #3 PAL CARD NUMBER

• OPERATOR #4 NAME

• OPERATOR #4 PAL CARD NUMBER

• Who has completed this inspection

• Please sign to confirm this inspection has been completed by the person named above

  Sign