Dock Loader

• Client

• Dock Leveler

• Conducted on

  Date

• Prepared by

• Location
  Address

• SERIAL NUMBER:

• MRC:

• Next service Due:

  Date

• Make:

• Model:

• DOM:

Structure

• Foundations

  Safe

  At Risk

  N/A

• Structure integrity

  Safe

  At Risk

  N/A

• Free of visual cracking

  Safe

  At Risk

  N/A

• Footings

  Safe

  At Risk

  N/A

• Foundation bolting

  Safe

  At Risk

  N/A

• machinery guarding

  Safe

  At Risk

  N/A

• Rear lip hinge

  Safe

  At Risk

  N/A

• Chains and ropes

  Safe

  At Risk

  N/A

• cable / chain terminations

  serviceable

  monitor

  repair required

  lock out

  not applicable

Electrical

• lockable isolator point

  Yes

  No

  N/A

• operation controls

  Safe

  At Risk

  N/A

• Contactors

  serviceable

  monitor

  repair required

  lock out

  not applicable

• safety devices

  Safe

  At Risk

  N/A

• clear movement directions

  Pass

  Fail

  N/A

• travel limit raise

  Pass

  Fail

  N/A

• travel limit lower

  Pass

  Fail

  N/A

General

• operating manual

  Yes

  No

  N/A

• isolator signage

  Pass

  Fail

  N/A

• operation signage

  Safe

  At Risk

  N/A

• operation instructions

  Yes

  No

  N/A

Hydraulics / Pneumatics

• power Pack

  Safe

  At Risk

  N/A

• hydraulic type displayed

  Yes

  No

  N/A

• hydraulic fluid level

  Yes

  No

  N/A

• air / fluid pressures

  Yes

  No

  N/A

• air / fluid leaks

  Yes

  No

  N/A

• Hoses

  Safe

  At Risk

  N/A

• Cylinders

  Safe

  At Risk

  N/A

Locating Conditions

• Side door seal

  Safe

  At Risk

  N/A

• Side Air bags

  Safe

  At Risk

  N/A

• Bumpers

  Safe

  At Risk

  N/A

• clean out pit

  Yes

  No

  N/A

Mechanical

• guide rollers

  Yes

  No

  N/A

• sprockets or sheaves

  Yes

  No

  N/A

• Lubricate all points as req

  Yes

  No

  N/A