Daily Lift Inspection Form

• Lift #

• Job Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Each lift will be operationally tested and visually inspected each day. The designated inspector completing this checklist must answer "Safe", "At Risk" or "N/A" for each item. Add any relevant notes and media attachments to items. Immediately notify the Foreman of any aerial lift deficiencies. The Foreman will forward all daily inspection forms to the HR/Safety Manager at the end of each week.

Functions & Operating Controls

• Emergency Stop & Brakes (shuts off controls & engine)

  Safe

  At Risk

  N/A

• All Operation Controls, switches, gauges and instruments operate properly

  Safe

  At Risk

  N/A

• Detents properly lock controls in place. Check condition of control enclosures and protective boots/guards.

  Safe

  At Risk

  N/A

• Brakes operate properly

  Safe

  At Risk

  N/A

• Safety Signs (Readable)

  Safe

  At Risk

  N/A

• Emergency stop switches at the ground & platform control stations operate properly

  Safe

  At Risk

  N/A

Platform Assembly

• Platform rails installed & secure, midrail chain/gate and bars installed & latch properly

  Safe

  At Risk

  N/A

• Platform extension deck & related components secure & undamaged

  Safe

  At Risk

  N/A

Platform Assembly

• Scissor arms free of damage

  Safe

  At Risk

  N/A

• Arm safety props operational

  Safe

  At Risk

  N/A

• Cylinder pins, pivot pins & attaching hardware secure & undamaged

  Safe

  At Risk

  N/A

• Arm pins, wear pads & attaching

  Safe

  At Risk

  N/A

• Hardware secure & undamaged

  Safe

  At Risk

  N/A

• Anchorage Points

  Safe

  At Risk

  N/A

Hydraulic/Electrical system

• All cylinders free of leaks and damage

  Safe

  At Risk

  N/A

• Leaks

  Safe

  At Risk

  N/A

• Hydraulic oil level in tank correct

  Safe

  At Risk

  N/A

• Hydraulic tank cap tight & vent open

  Safe

  At Risk

  N/A

• All electrical connections tight, no corrosion or abrasions

  Safe

  At Risk

  N/A

Power system

• Engine idle, throttle & RPM set properly

  Safe

  At Risk

  N/A

• Fluid levels correct, hydraulic tank, engine oil torque hubs, coolant & batteries

  Safe

  At Risk

  N/A

• Air & fuel filter clean

  Safe

  At Risk

  N/A

• Exhaust system free of leaks (gas/diesel units only)

  Safe

  At Risk

  N/A

Chassis

• Wheel rim nuts torqued properly

  Safe

  At Risk

  N/A

• Check tires for proper inflation, damage & wear

  Safe

  At Risk

  N/A

• Steer, drive & axle components secure & undamaged

  Safe

  At Risk

  N/A

• Outrigger/ stabilizers operate properly

  Safe

  At Risk

  N/A

• Hydraulic tray & battery/engine compartment covers open & latch properly

  Safe

  At Risk

  N/A

Manual & Decals

• Manual of responsibilities in manual storage box

  Safe

  At Risk

  N/A

• Operators & safety manual available

  Safe

  At Risk

  N/A

• All instruction & safety placards installed & legible

  Safe

  At Risk

  N/A

General

• Lift is free of unauthorized modification or additions

  Safe

  At Risk

  N/A

• Additional notes

Signature

• Foreman's Signature (daily optional)

  Sign