Information

  • Customer

  • Prepared by

Customer Details

  • Company Name

  • Customer Contact Requesting Survey

  • Account Number

  • Initial Platform Hire Contact

  • Site Contact

  • Date survey was requested

  • Address of site

Machine Requirements

  • What WORKING HEIGHT is required (m)?

  • Is outreach required?

  • How much outreach is required (m)?

  • Are you booming up and over an object or building?

  • At what height do you require the knuckle to reach (m)?

  • What is the machine being used to do?

Site Restrictions

  • Are there height restrictions?

  • What is the height restrictions (m)?

  • Is there a width restriction?

  • What are the width restrictions?

  • Is there a weight restriction?

  • What is the weight restictions (m)?

  • Is there a length restriction?

  • What is the length restriction (m)?

  • is there any obstructions or obstacles?

  • What obstacles / hazards are there?

  • What are the ground conditions / gradients?

  • Delivery Restrictions (Truck Access / Timed Access)

  • What are the restrictions

Working on a road / pavement

  • Type of Road (Private / 30mph / Pedestrian area)

  • Permit Likely Required

  • Additional Survey Required (Traffic Management / specific machine specialist)

  • Notes of 'working on road' restrictions / requirements / comments / observations

Machine Selection

  • Date Machine Required

  • 1st Choice Machine

  • Alternative Machine (if possible)

  • Date survey taken out

  • Was site contact present

  • Surveyor Signature

  • Site Pictures

  • Sketch of site / building

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.