Counter Balance Pre-Use Inspection

• Equipment make/model/unit no.

• Job site name/ location description (inside,outside,north parking lot, loading doc, etc.)

• Conducted on

  Date
• Location
  Address

• Prepared by

WORKPLACE INSPECTION

• Acceptable?
  Yes - no explanation needed
  No- details and photo needed
  N/A - not applicable

• Drop-off or holes<br>

  Yes

  No

  N/A

• Bumps & Floor/Ground obstruction

  Yes

  No

  N/A

• Debris

  Yes

  No

  N/A

• Overhead Obstructions

  Yes

  No

  N/A

• Energized power lines

  Yes

  No

  N/A

• Hazardous locations

  Yes

  No

  N/A

• Ground surface & support conditions

  Yes

  No

  N/A

• Pedestrian /vehicles traffic

  Yes

  No

  N/A

• Wind & Weather Conditions

  Yes

  No

  N/A

• Other possible hazards

  Yes

  No

  N/A

• Please submit photo and description of non acceptable conditions

  Media

• General comments and deficiency's

Walk-Around Items (visual)

• Walk-around inspection (warning decals,capacity plate, etc)

  Yes

  No

  N/A

• Forks/locking pins,carriage,mast

  Yes

  No

  N/A

• Wheels,tires & lug nuts (condition/Pressure)

  Yes

  No

  N/A

• Battery(electrolyte levels,connections)

  Yes

  No

  N/A

• Engine (fluid levels,leaks,belts,hoses,debris

  Yes

  No

  N/A

• Transmission (fluids level,leaks)

  Yes

  No

  N/A

• Air cleaner (clean or change required)

  Yes

  No

  N/A

• Radiator (fluid level,leaks)

  Yes

  No

  N/A

• Hydraulic tank (fluid level, leaks

  Yes

  No

  N/A

• Fuel tank (secure,valve open & fuel level)

  Yes

  No

  N/A

• Overhead guard (no damage)

  Yes

  No

  N/A

• Seatbelt

  Yes

  No

  N/A

• Please submit photo and description of any non acceptable items found during visual walk around

  Media

• Deficiency's

Start-Up Checks

• Engine (sounds normal no excessive exhaust smoke)

  Yes

  No

  N/A

• Gauges/warning lights (fuel /charge level, oil pressure, etc.)

  Yes

  No

  N/A

• Wipers & Lights

  Yes

  No

  N/A

• Warning devices (horn, back-up alarm, strobe lights, etc.)

  Yes

  No

  N/A

• All powered controls

  Yes

  No

  N/A

• Direction / speed controls

  Yes

  No

  N/A

• All Brakes

  Yes

  No

  N/A

• Steering

  Yes

  No

  N/A

• Fuel / Charge Levels

  Yes

  No

  N/A

• Other ( describe below)

  Yes

  No

  N/A

• Please submit photo of deficiency's and make appropriate notes below

  Media

• Notes /deficiency reporting