Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Project:
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Location:
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Contractor:
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Qualified User/Operator (full name):
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Motorized Unit Serial Number:
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Date (Week of):
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Each Hydro Mobile motorized unit and its accessories must be inspected daily or before every working shift, as well as weekly. These inspections must be carried out by a qualified user/operator. Use the spaces below to monitor 6 days of the daily and weekly inspections. Use the Notes and Comments form to indicate any discrepancy or any item found to be not acceptable. Any discrepancy must be reported and appropriate corrective action must be taken immediately. Corrective actions must be performed by a qualified technician. "Qualified" means a person who, by possession of a recognized degree, certificate or professional standing, or who by extensive knowledge, training and experience, has successfully demonstrated the ability to solve or resolve problems relating to the subject matter, the work or the project. Only a qualified user/operator on the specific make and model of the Hydro Mobile equipment is allowed to perform daily and weekly maintenance inspections and only a qualified technician on the specific make and model of the Hydro Mobile equipment is allowed to perform repair on the Hydro Mobile units. These inspections and repairs must be performed according to the guidelines, instructions, warnings and methods set out in the owner's manuals and Hydro Mobile training courses.
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USE CHECK MARK FOR EACH ENTRY VERIFIED. IF NECESSARY, TAKE CORRECTIVE ACTION BEFORE INSERTING CHECK MARK.
ACCESS and SAFETY
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SERIAL NUMBER (if applicable):
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1. Access stairs, ramps and door are clear of any obstruction and in good condition.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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2. All access panels are clear of material and equipment.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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3. All safety guardrails are in position and doors are operational (no fall hazard).
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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4. An evacuation plan specific to the job site is available to all workers and a legible copy of the owner’s manual is in the tool box.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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5. Construction traffic is controlled on and around job site (proper barriers installed).
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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6. If the work platform is accessed from inside the building or off a scaffold stair tower, transfer is safe and free from obstruction.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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7. Mast climbing is not impeded in any way and on a motorized unit equipped with an access bridge, the access walkway is clear of debris and working properly.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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8. Minimum clearance from overhead power lines is maintained according to local regulation.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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9. On special façade shapes, cross box kits, face guardrails and plank guardrails are properly installed and secure.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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10. Perimeter of setup is safe and delimited (warning tape, concrete blocks).
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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11. Setup and installation meet the requirements prescribed by owner’s manual or approved engineering drawing.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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12. The platform clears all obstacles (building, balconies, etc.) and can be raised or lowered.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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13. Work and circulation areas on the platform are clear of any obstruction.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
BASE
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SERIAL NUMBER (if applicable):
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14. Base is level and cribbing under jacks has not moved.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
MOTORIZED UNIT – COMPONENTS
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SERIAL NUMBER (if applicable):
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15. Control joystick has been verified and is functioning properly.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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16. Each cylinder hook, secondary hook and lowering cam is in good condition and functioning properly
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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17. Each cylinder, hydraulic hose and hydraulic component is free of leaks and signs of wear.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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18. Each roller has been greased using Prolab GS1000 #28840 only. (WEEKLY)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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19. Each roller has been verified and is in good condition.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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20. Emergency stop has been verified and is working properly. IGNITION MUST BE TURNED OFF when the unit is not in operation.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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21. Gasoline and engine oil levels are appropriate or have been replenished. Air filter has been verified and is in good condition or has been replaced, if necessary.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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22. Hydraulic oil level has been verified and hydraulic tank has been replenished, if required, with oil recommended by Hydro Mobile.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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23. Lifting mechanism is clear of debris (mortar, masonry material, etc.) and shows no signs of excessive wear.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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24. Motorized unit structure has been inspected and shows no signs of damage or distortion.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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25. On an electrical unit, the power cable has been inspected and shows no signs of damage. Input power is adequate and phases are in sync.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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26. On an electrical unit, the routing of the power cable is free from obstruction and the cable recoils properly.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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27. Rubber on each cylinder hook has been verified as described in Owner’s manual procedure and is in good condition.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
MOTORIZED UNIT – SAFETY DEVICES
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SERIAL NUMBER (if applicable):
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28. Each backup safety hook has been inspected and shows no sign of engagement prior to inspection. Each safety hook is clean and can move freely. Motorized unit must be put out of service if any safety hook is found to be defective or shows signs of having been engaged previously
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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29. With the setup at 10' (3 m) above the bearing surface and without any loads on the platform, testing of the emergency descent system has been performed (on installation and subsequently once a week) to make sure it is operating normally. (WEEKLY)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
MASTS and MAST TIES
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SERIAL NUMBER (if applicable):
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30. Mast bolts are tightened at the proper torque (120 lb-ft or 163 N-m). Mast bolt washers have been replaced if bent. (WEEKLY)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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31. Mast is plumb (both front and side axis) and all bolts and nuts are in position.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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32. Mast sections have been inspected and show no signs of damage or distortion
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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33. Mast ties are in good condition, show no signs of distortion and are secure (collision with planks or mast tie doors can damage ties).
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
BRIDGES and PLANKING
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SERIAL NUMBER (if applicable):
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34. Bridges have been inspected and their structure shows no signs of damage or distortion.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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35. On a bearing bridge, the inclinometers have been verified and detect ±2-degree slopes at both ends of the structure.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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36. On linear bearing bridges, there is a 6" to 12" (15 cm to 30 cm) overlap at each end and bridge safety chains are tied properly with a slack not exceeding 1" (2,5 cm).
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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37. Plank outriggers are clean and in good condition. Outrigger lock bolts are all tightened properly and plank stop pins are in place.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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38. Planking is in good condition and set properly. Planking clears all obstacles (building, balconies, etc.) and is properly supported, overlapped and secured.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
LOADS
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39. Loads on the platform do not exceed those prescribed by the capacity charts and are equally distributed.
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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The undersigned certifies that this unit and its accessories have been properly inspected, in due time, that any discrepancy has been brought to the attention of the
owner/user and that all discrepancies have been corrected prior to further use of this unit or its accessories. -
Signature of QUALIFIED USER/OPERATOR
Day
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Signature
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Date of Inspection
Notes and Comments
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NAME of QUALIFIED USER/OPERATOR:
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MOTORIZED UNIT MODEL and SERIAL NUMBER:
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DATE of INSPECTION:
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Add notes and comments.
Note/Comment
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Date Entered
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Note or Comment
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Corrective Action Required
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Date of Report to Owner/User
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Date of Completion for Corrective Action
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The undersigned certifies that this unit and its accessories have been properly inspected, in due time, that any discrepancy has been brought to the attention of the
owner/user and that all discrepancies have been corrected prior to further use of this unit or its accessories. -
Name and Signature of QUALIFIED PERSON
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Date of Inspection
