Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Unit Number or Make/Model Number

  • Type of MEWP

  • I have completed Aerial Lift (MEWP) and Fall Protection training prior to use.

  • I have inspected my Fall Protection equipment prior to use.

Visual Inspection

  • Visual Inspection - missing or loose parts/bolts, broken welds, and structural damage.

  • Leaks - loose or damaged hoses; look for fluid on the ground. Check oil, hydraulic, fuel, and coolant levels.

  • Wheels/Tires - no cuts, bulges, or damage. Check for missing or loose lugs.

  • Platform Integrity - No damage or missing parts, railing secure, tie-off points secure, gate lock is functional.

  • Lifting Structural Members (Boom, Scissor, Mast) - Check supporting members for damaged, broken, or bent parts.

  • Fiberglass and Other Insulating Parts - in good working order.

  • Mechanical Fasteners and Locking Pins - are in good working order. Positioning lines, tie wires, or jack bolts are secure and have not moved.

  • Hour Meter - is operating correctly.

  • Hour Meter - Reading

  • Battery & Connectors - are tight fitting and not cracked or burnt, battery water level correct, vent caps in place, clean.

Operational Controls - Function Testing

  • Ground Controls - function smoothly, proper operation, E-stop works, controls are clearly labeled and return to neutral.

  • Safety Devices - horn, beeping signal, indicator lights, labels legible, emergency decent functions, in condition as equipped.

  • Steering - has no binding, no excessive play, and controls return to neutral.

  • Travel Controls - all speed ranges, forward and reverse, with no unusual noise.

  • Hydraulic Controls - raise and lower, with no unusual noise.

  • Brakes - stop lift within the required distance and work smoothly.

  • Outriggers - functional with no unusual noise.

  • Upper Control Station - functions smoothly, with proper operation, E-stop works, controls are clearly labeled and return to neutral.

  • Power Disconnect - cuts off all electrical power.

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