Information
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Call No.
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Meter Reading
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Customer Info
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Date
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Customer
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Unit No.
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Make
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Model
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Meter Reading
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Technician
Visual
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Over head Guard
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Mast
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Capacity Plate & Safety Decals
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Tires & Wheels
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Seat & Seat Belt
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Leaks
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Note any bent or damaged parts
Brakes
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Visual Inspection: All Brake Components
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Foot and Park Brake Operation
Steering
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Linkage, King Pins, Tie Rods, Pivot
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Cylinder
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Operation
Frame
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Check all Tires, Rim, Pressures
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Hood, Latch, Struts
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Counter Weight Bolt
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Dash, Floor Board, Coverings
Electrical
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Dash, Display, Switches
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Battery
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Wiring, Connections, Cables
Power Train
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Engine System
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Transmission
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Differential
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Fuel System
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Cooling System
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Clean Radiator
Mast and Hydraulics
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Inspect Forks
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Reason for Failure
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Load Back Rest
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Mast Channels and Rollers and Mounting
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Carriage, Rollers
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Inspect Lift Chains and Anchors
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Reason for Failure
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Pivot - Bushings/Bearings, Mounts
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Attachment
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Cylinders
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Pump(s)
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Hoses and Pulleys
Operational Check and Test Drive
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Seat Switch
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Test Drive and Functional Test
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Lighting and Alarms
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Fire Extinguisher
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Operators Manual
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Horn
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Clean unit and work Area
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Additional Comments
Fluid Levels
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Greased & Lubed
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Engine Oil
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Air Filter Clean/Renewed
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Coolant
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Trans Oil
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Diff Oil
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Brake Oil
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Hydraulic Oil
CSA Annual Inspection
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Attach Maintenance/inspection sticker
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Unit Passes Inspection
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Next Annual Inspection Due
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