DOA LIFT EQUIPMENT OPERATOR PRACTICAL

• Document No.

• Operator

• Conducted on

  Date

Operator

• Name

• Shop

• Badge

Equipment

• Type

  Vertical

  Scissor

  Articulated

  Straight mast

• Manufacturer

• Model

• Asset number

• Photo

  Media

PRE-USE INSPECTION - WORK AREA

• Operating Area

  Safe

  At Risk

  N/A

• Surface (level, flat, etc)

  Safe

  At Risk

  N/A

• Overhead Obstructions (pipes, ducts, lights, beams, etc.)

  Safe

  At Risk

  N/A

• Debris, housekeeping

  Safe

  At Risk

  N/A

• Pedestrians, bystanders

  Safe

  At Risk

  N/A

• Personal Protective Equipment (PPE)

  Safe

  At Risk

  N/A

• Hazardous atmosphere

  Safe

  At Risk

  N/A

• Fire safety (extinguisher, sprinklers, exits, etc.)

  Safe

  At Risk

  N/A

• Weather (wind, rain, etc.). Do not operate in wind over 20mph sustained or 25mph gusts.

  Safe

  At Risk

  N/A

• Other

• Photo of discrepancy

  Media

PRE-USE INSPECTION - EQUIPMENT

• Fuel, battery

  Safe

  At Risk

  N/A

• Motor

  Safe

  At Risk

  N/A

• Hydraulic fluid

  Safe

  At Risk

  N/A

• Fluid Leaks

  Safe

  At Risk

  N/A

• Lower controls

  Safe

  At Risk

  N/A

• Upper controls

  Safe

  At Risk

  N/A

• Platform

  Safe

  At Risk

  N/A

• Railings

  Safe

  At Risk

  N/A

• Nuts & bolts

  Safe

  At Risk

  N/A

• Gate/chain secured

  Safe

  At Risk

  N/A

• Wheels, tires

  Safe

  At Risk

  N/A

• Warning, capacity labels in place & legible

  Safe

  At Risk

  N/A

• Interlocks

  Safe

  At Risk

  N/A

• Other safety devices

  Safe

  At Risk

  N/A

• Motion alarm sounds

  Safe

  At Risk

  N/A

• Gages, warning lights

  Safe

  At Risk

  N/A

• Steering

  Safe

  At Risk

  N/A

• Outriggers, stabilizers

  Safe

  At Risk

  N/A

• Extension deck

  Safe

  At Risk

  N/A

• Parking brake

  Safe

  At Risk

  N/A

• Photo of discrepancy

  Media

OPERATION

• PPE

  Safe

  At Risk

  N/A

• Gate/chain secure

  Safe

  At Risk

  N/A

• Fall protection (boom lift only)

  Safe

  At Risk

  N/A

• Driving

  Safe

  At Risk

  N/A

• Speed

  Safe

  At Risk

  N/A

• Maneuvering

  Safe

  At Risk

  N/A

• Controls

  Safe

  At Risk

  N/A

• Outriggers set (if equipped)

  Safe

  At Risk

  N/A

• Deck extension (if equipped)

  Safe

  At Risk

  N/A

• Raise/lower platform

  Safe

  At Risk

  N/A

• Boom control (if equipped)

  Safe

  At Risk

  N/A

• Reposition raised

  Safe

  At Risk

  N/A

• Other

SHUT DOWN

• Select location

  Safe

  At Risk

  N/A

• Platform secure

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Controls neutralized

  Safe

  At Risk

  N/A

• Power off

  Safe

  At Risk

  N/A

• Remove key

  Safe

  At Risk

  N/A

• Brake set

  Safe

  At Risk

  N/A

• Battery charging

  Safe

  At Risk

  N/A

• Cord trip hazard

  Safe

  At Risk

  N/A

OTHER

• Other notable items

• Photo of notable item

  Media

SIGNATURES

• Operator

  Sign

• Trainer

  Sign

• PASSED