Title Page
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Site conducted
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Conducted on
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Prepared by
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Unit Number or Make/Model Number
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Type of MEWP
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I have completed Aerial Lift (MEWP) and Fall Protection training prior to use.
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I have inspected my Fall Protection equipment prior to use.
Visual Inspection
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Visual Inspection - missing or loose parts/bolts, broken welds, and structural damage.
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Leaks - loose or damaged hoses; look for fluid on the ground. Check oil, hydraulic, fuel, and coolant levels.
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Wheels/Tires - no cuts, bulges, or damage. Check for missing or loose lugs.
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Platform Integrity - No damage or missing parts, railing secure, tie-off points secure, gate lock is functional.
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Lifting Structural Members (Boom, Scissor, Mast) - Check supporting members for damaged, broken, or bent parts.
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Fiberglass and Other Insulating Parts - in good working order.
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Mechanical Fasteners and Locking Pins - are in good working order. Positioning lines, tie wires, or jack bolts are secure and have not moved.
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Hour Meter - is operating correctly.
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Hour Meter - Reading
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Battery & Connectors - are tight fitting and not cracked or burnt, battery water level correct, vent caps in place, clean.
Operational Controls - Function Testing
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Ground Controls - function smoothly, proper operation, E-stop works, controls are clearly labeled and return to neutral.
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Safety Devices - horn, beeping signal, indicator lights, labels legible, emergency decent functions, in condition as equipped.
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Steering - has no binding, no excessive play, and controls return to neutral.
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Travel Controls - all speed ranges, forward and reverse, with no unusual noise.
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Hydraulic Controls - raise and lower, with no unusual noise.
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Brakes - stop lift within the required distance and work smoothly.
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Outriggers - functional with no unusual noise.
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Upper Control Station - functions smoothly, with proper operation, E-stop works, controls are clearly labeled and return to neutral.
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Power Disconnect - cuts off all electrical power.
