CNMEC - Aerial Device Inspection - Daily

• Vehicle #

• Conducted on

  Date

• Prepared by

• Location
  Address

• INSTRUCTIONS
  
  1. Please answer "Yes", "No" or "N/A" on the questions below.
  2. Add Photos and Notes by clicking on the Paperclip icon
  3. To add a Corrective Measure click on the Paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
  4. Complete audit by providing digital signature
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

FIBERGLASS CLEAN AND UNDAMAGED

• Bucket

  Yes

  No

  N/A

• Liner

  Yes

  No

  N/A

• Upper Boom

  Yes

  No

  N/A

• Lower Boom

  Yes

  No

  N/A

• Lift Arm

  Yes

  No

  N/A

• Other

EQUIPMENT SECURE AND IN PLACE

• Safety Belts

  Yes

  No

  N/A

• Belt anchor

  Yes

  No

  N/A

• Boom Latches

  Yes

  No

  N/A

• Rescue Device

  Yes

  No

  N/A

• Safety Decals

  Yes

  No

  N/A

• Other

EQUIPMENT OPERATIONAL

• Upper Controls

  Yes

  No

  N/A

• Control Lockout

  Yes

  No

  N/A

• Lower Controls

  Yes

  No

  N/A

• Outtrigers

  Yes

  No

  N/A

• Outrigger Lockout

  Yes

  No

  N/A

• Outrigger Belt

  Yes

  No

  N/A

• Start/Stop Switch

  Yes

  No

  N/A

• Throttle Control

  Yes

  No

  N/A

• Tool Circuits

  Yes

  No

  N/A

• Other

TRUCK

• TRUCK WAS PRE-FLIGHTED

  Yes

  No

  N/A

• TRUCK GROUNDS

  Yes

  No

  N/A

• Other

UNIT RESULTS

• Safe for further use

  Yes

  No

  N/A

• Other

EQUIPMENT LUBED AND WITHOUT EXCESS WEAR

• Compensation Chain

  Yes

  No

  N/A

• Boom Hinge Point

  Yes

  No

  N/A

• Platform Hinge Point

  Yes

  No

  N/A

• Cylinder Hinge Point

  Yes

  No

  N/A

• Platform Rotation Point

  Yes

  No

  N/A

• Lift Cables/Rods

  Yes

  No

  N/A

• Leveling Cable/Cylinder

  Yes

  No

  N/A

• Capstan Unit

  Yes

  No

  N/A

• Sheaves/liners

  Yes

  No

  N/A

• Other

EQUIPMENT WITHOUT LEAKS AND DAMAGE

• Hydraulic Lines/Hoses

  Yes

  No

  N/A

• Cylinders

  Yes

  No

  N/A

• Hydraulic Fittings

  Yes

  No

  N/A

• Valves

  Yes

  No

  N/A

• Hydraulic

  Yes

  No

  N/A

• Reservoir

  Yes

  No

  N/A

• Air Lines/Tanks

  Yes

  No

  N/A

• Dielectric Tool Hoses

  Yes

  No

  N/A

• Tool Outlets

  Yes

  No

  N/A

• Other

WELDS VISIBLY INTACT

• Boom

  Yes

  No

  N/A

• Turret

  Yes

  No

  N/A

• Utitlity

  Yes

  No

  N/A

• Body

  Yes

  No

  N/A

• Truck Frame

  Yes

  No

  N/A

• Outriggers

  Yes

  No

  N/A

• Other

TESTING DATA

• Date of last Dielectric and Structural Test

  Date

• Performed by (Name & Signature)

  Sign

COMPLETION

• Maintenance request was submitted?

  Yes

  No

  N/A

• Request submitted to?

  Yes

  No

  N/A

• Repairs have been completed?

  Yes

  No

  N/A

• Repairs completed by?

  Yes

  No

  N/A

• Inspector's Name & Signature

  Sign