Equipment Safety Survey

• Job Site Name/Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Superintendent/Foreman

• Operator(s)

General Information

• Equipment being inspected?

  Select Aerial Lift Air Compressor Back Hoe Crane Drill Rig Excavator Fork Lift Grout Pump Loader Low Head Rig

  • Aerial Lift
  • Air Compressor
  • Back Hoe
  • Crane
  • Drill Rig
  • Excavator
  • Fork Lift
  • Grout Pump
  • Loader
  • Low Head Rig

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• Engine Hours

• Is equipment being operated properly?

  Yes

  No

  N/A

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• Is Regular Preventative Maintenance being performed?

  Yes

  No

  N/A

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• Are equipment repairs needed?

  Yes

  No

  N/A

• Have repairs been requested?

  Yes

  No

  N/A

• Who was notified?

  Select HJ Shop Rental Outfit

  • HJ Shop
  • Rental Outfit

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• Is the operator familiar w/ the equipment's Operator Manual?

  Yes

  No

  N/A

Crane(s)

• Daily Inspection completed?

  Yes

  No

  N/A

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• Working platform stable and level?

  Safe

  At Risk

  N/A

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• Equipment properly set up?

  Safe

  At Risk

  N/A

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• Swing Radius clear?

  Safe

  At Risk

  N/A

• Type

  Select Barricades Caution Tape Danger Tape

  • Barricades
  • Caution Tape
  • Danger Tape

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• Equipment properly maintained?

  Yes

  No

  N/A

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• Operator's Manual in equipment?

  Yes

  No

  N/A

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• Weight Sheet in equipment? [weights known, radius known]

  Yes

  No

  N/A

Drill Rig(s)

• Daily Inspection completed?

  Yes

  No

  N/A

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• Working platform stable and level?

  Safe

  At Risk

  N/A

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  Media

• Equipment properly set up?

  Safe

  At Risk

  N/A

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• Equipment properly maintained?

  Yes

  No

  N/A

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• Swing Radius clear?

  Safe

  At Risk

  N/A

• Type

  Select Barricades Caution Tape Danger Tape

  • Barricades
  • Caution Tape
  • Danger Tape

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• Operator's Manual in equipment?

  Yes

  No

  N/A

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Heavy Equipment: [Aerial Lift, Excavator, Forklift...]

• Daily Inspection completed?

  Yes

  No

  N/A

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• Is the operator qualified?

  Yes

  No

  N/A

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• Equipment properly maintained?

  Yes

  No

  N/A

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• Operator's Manual in equipment?

  Yes

  No

  N/A

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• All employees are aware of equipment's work area(s)?

  Yes

  No

  N/A

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Rigging

• Winches [breaks, dogs/locks, hydraulics]

  Safe

  At Risk

  N/A

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• Wire Rope properly wrapped on drums

  Safe

  At Risk

  N/A

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• Proper length of Wire Rope on machine

  Yes

  No

  N/A

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• Beckets and Cable Clamps

  Safe

  At Risk

  N/A

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• Sheaves

  Safe

  At Risk

  N/A

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• Hooks and Swivels

  Safe

  At Risk

  N/A

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Electrical

• E-Stops working properly and inspected

  Safe

  At Risk

  N/A

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• Instrumentation [Oil Pressure, Temperature...]

  Safe

  At Risk

  N/A

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• Wire Harness(s)

  Safe

  At Risk

  N/A

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• Batteries and Battery Terminals

  Safe

  At Risk

  N/A

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• Power Tools and Cords [tool/extension]

  Safe

  At Risk

  N/A

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• Generator(s) [grounded]

  Safe

  At Risk

  N/A

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Other

• Are extra fluids on site? [hydraulic, gear and engine oils, grease...]

  Yes

  No

  N/A

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• Is a spill kit on site?

  Yes

  No

  N/A

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• Are rotating parts guarded? [covers, grates...]

  Safe

  At Risk

  N/A

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• Are catwalks/steps clear and in good shape?

  Safe

  At Risk

  N/A

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• Are fire extinguishers tagged and in good shape? [ABC extinguisher]

  Safe

  At Risk

  N/A

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• Annual inspection complete? [if applicable]

  Yes

  No

  N/A

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Comments, Corrective Actions, or other Safety Observations

• Inspector(s)

  Sign

• Superintendent and/or Foreman

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