Corporate Construction Group (CCG) - Aerial Lift Checklist

• Project Name

• Prepared by

• Title

• Project Manager

• Conducted on

  Date
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1. Personnel Safe Work Practices

• a. Only authorized and trained personnel operating aerial lifts

  Yes

  No

  N/A

• b. Aerial lifts inspected by the operator prior to use

  Yes

  No

  N/A

• c. Lift controls tested by the operator each day prior to use

  Yes

  No

  N/A

• d. Personnel wearing full body harness with lanyard attached to boom or platform

  Yes

  No

  N/A

• e. Lanyards not attached to adjacent structures or equipment while in aerial lift

  Yes

  No

  N/A

• f. Personnel standing firmly on the floor of lift platform

  Yes

  No

  N/A

• g. Personnel remain in the platform at all times and do not climb to adjacent structures

  Yes

  No

  N/A

2. General

• a. Standard guardrail or equivalent protection provided on lift platform

  Yes

  No

  N/A

• b. Aerial lifts provided with upper and lower controls.

  Yes

  No

  N/A

• c. Lower controls operated only with permission of personnel in lift, unless emergency

  Yes

  No

  N/A

• d. Lift controls properly marked and legible, and capacity rating posed on lift

  Yes

  No

  N/A

• e. Modifications to aerial lift certified in writing by manufacturer

  Yes

  No

  N/A

3. Aerial Lift Positioning

• a. Aerial lifts positioned on firm, level surface with brakes set

  Yes

  No

  N/A

• b. Wheel chocks used on inclines

  Yes

  No

  N/A

• c. Outriggers positioned on solid surfaces or cribbing when used

  Yes

  No

  N/A

• d. Safe clearance distance maintained while working near overhead powerlines

  Yes

  No

  N/A

• e. Safe clearance distance maintained while travelling under overhead powerlines

  Yes

  No

  N/A

• f. Aerial lifts not moved when boom is elevated and personnel are working in platforms

  Yes

  No

  N/A

• g. Boom is properly cradled and outriggers stowed prior to moving aerial lift for travel

  Yes

  No

  N/A

4. Aerial Lift Operation

• a. Safe operating manual should be available for review and use by aerial lift operators

  Yes

  No

  N/A

• b. Aerial lift operators know boom and basket load limits and do not exceed them

  Yes

  No

  N/A

• c. Aerial lift platforms are free of slippery conditions

  Yes

  No

  N/A

• d. Personnel not standing or working below aerial lift operations

  Yes

  No

  N/A

• e. Warning signs or barricades provided under aerial lift operations

  Yes

  No

  N/A

• f. Counterweight swing radius barricaded or flagged

  Yes

  No

  N/A

• g. Aerial lifts not being used as cranes

  Yes

  No

  N/A

• h. Platforms free of attachments such as cables, wires, chains, or ropes

  Yes

  No

  N/A

• i. Aerial lifts not operated in winds exceeding 20 miles per hour

  Yes

  No

  N/A

• j. Platform foot switch physically operated and not mechanically blocked or by-passed

  Yes

  No

  N/A

• k. Insulating portion of aerial lift is not altered in any manner

  Yes

  No

  N/A

• l. Aerial lifts used indoors have exhaust properly vented to control carbon monoxide exposure

  Yes

  No

  N/A

Corrective Action Taken

• Corrective actions & dates corrected

• Signature

  Sign