EQUIPMENT DEMO

• Document No.

• MWB Weekly Safety Inspection report

• Client / Job Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Superintendent

• Equipment & Scaffold - Select from Multiple Choice

Equipment

• Select Scaffold Scissor/Articulate Lifts Crane Forklift

  • Scaffold
  • Scissor/Articulate Lifts
  • Crane
  • Forklift

• Responsible Party for Crane

• Inspection Certificate

  Acceptable

  Unacceptable

  Not Applicable

• Fire Extinguisher

  Acceptable

  Unacceptable

  Not Applicable

• Load Limit

  Acceptable

  Unacceptable

  Not Applicable

• Swing Radius Protected

  Acceptable

  Unacceptable

  Not Applicable

• Operated Certified

  Acceptable

  Unacceptable

  Not Applicable

• Rig/Signal Certified

  Acceptable

  Unacceptable

  Not Applicable

• Loads Secured

  Acceptable

  Unacceptable

  Not Applicable

• Tag Line

  Acceptable

  Unacceptable

  Not Applicable

• Spreaders with PE letter

  Acceptable

  Unacceptable

  Not Applicable

• Crane Basket Per OSHA Standard 1926,150(g)

  Acceptable

  Unacceptable

  Not Applicable

• Responsible Party for Scaffold

GuardRails

• Top

  Acceptable

  Unacceptable

  Not Applicable

• Mid-Rail

  Acceptable

  Unacceptable

  Not Applicable

• Toe Board

  Acceptable

  Unacceptable

  Not Applicable

• X Bracket Secured

  Acceptable

  Unacceptable

  Not Applicable

• Base Plates Used

  Acceptable

  Unacceptable

  Not Applicable

• Legs on Solid Material

  Acceptable

  Unacceptable

  Not Applicable

• Loads Double Planked

  Acceptable

  Unacceptable

  Not Applicable

Secured

• 26' Vertically

  Acceptable

  Unacceptable

  Not Applicable

• 30' Horizontally

  Acceptable

  Unacceptable

  Not Applicable

Planks

• Secured

  Acceptable

  Unacceptable

  Not Applicable

• Pass Through Protected

  Acceptable

  Unacceptable

  Not Applicable

• Tag Daily

  Acceptable

  Unacceptable

  Not Applicable

Mobile Scaffold

• Wheels Locked/Chocked

  Acceptable

  Unacceptable

  Not Applicable

• Moved Correctly

  Acceptable

  Unacceptable

  Not Applicable

• Responsible Party for Lift

• Fall Protection

  Acceptable

  Unacceptable

  Not Applicable

• Edge Guard Stop

  Acceptable

  Unacceptable

  Not Applicable

• Gate Latch

  Acceptable

  Unacceptable

  Not Applicable

• Controls Visible

  Acceptable

  Unacceptable

  Not Applicable

• Responsible Party for Forklift

• Backup Alarm

  Acceptable

  Unacceptable

  Not Applicable

• Daily Inspection

  Acceptable

  Unacceptable

  Not Applicable

• Seat Belt

  Acceptable

  Unacceptable

  Not Applicable

• Fire Extinguisher

  Acceptable

  Unacceptable

  Not Applicable