Title Page

  • Conducted on

  • Prepared by

  • Location

General Information

  • Make/Model of Aerial Lift

  • Type of aerial lift (SELECT ONE)

  • Number of hours on equipment

  • Task to be performed

Pre-shift Inspection

  • Personal fall arrest system anchorage points

  • Check for hydraulic fluid, oil, fuel, and battery acid leaks

  • Fiberglass and other insulating components for visible damage or contamination

  • Missing or illegible placards, warnings, operational, instructional control markings

  • Visual inspection of all locking pins

  • Cables and wiring harness free of damage

  • Loose or missing parts

  • Operating manuals in weatherproof containers on the lift

  • Outriggers, stabilizers and other structures

  • Wheel chocks

  • Guardrail systems

  • Other items specified by the manufacturer

  • Personal protective equipment (harness, lanyard, safety glasses, gloves, hard hat, etc.)

Function Test

  • Raise platform

  • Lower Platform

  • Tilt Sensor test

  • Manual Lowering Valve test

  • Lights/strobes functioning properly

  • Horn

  • Speed Regulator

  • 'NA' applies to trailer-type lifts ONLY.

  • Throttle

  • 'NA' applies to trailer-type lifts ONLY.

  • Steering

  • 'NA' applies to trailer-type lifts ONLY.

  • Brakes

  • 'NA' applies to trailer-type lifts ONLY.

Workplace Inspection

  • 'Check Above'

  • Check elevated work area for hazards including:
    - Power lines
    - Beams
    - Fans
    - Pipes
    - Trees

  • 'Check below'

  • Check work area where lift will be driven/parked for:
    - Uneven Terrain
    - Soft areas
    - Debris
    - Dropoffs
    - Pedestrian Traffic

  • Weather Conditions

  • Inclement weather includes high winds and lightning

Comments

  • Is there any other information you need to report at the time of your inspection?

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