Information
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Company Name:
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Inspection title (company name followed by the words Lift Inspection)
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Document No.
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Enter Date
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Inspected by
- John Percy
- Matt Kugler
- Tim Horning
- Tim Schmidt
- Eric Percy
- John Pezzino
- Scott Ruchalski
- Cody Quinn
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Were there any repairs from last Audit.
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Were all the repairs completed.
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Lifting it Right and ANSI Booklet Present
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SEMI-ANNUALLY LIFT INSPECTION
LIFT
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Is there a QR CODE
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SCAN QR CODE
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Lift Label
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Lift identification Number
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Lift Model
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Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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What Height Lift?
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Lift Serial Number
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Pick Lift Style
- 2 POST
- 4 POST
- IN GROUND LIFT
- SCISSORS LIFTS
- SMART LIFT
- Other
Lift
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Observe Vehicle on Lift
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Area Cleanliness
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Is there a Spotting Dish Present
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Does the Manager want one installed
INSPECTION ITEMS
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Fluid level
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Hoses: Please Pick Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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Overhead Hoses
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Unit Hoses
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Left Cylinder Hose
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Right Cylinder Hose
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Unit Hoses
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Is the Lift Level and Plumb
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What is the concern?
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Electrical
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Motor
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Valves
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Sliders
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Cylinders
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Structure
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Sheaves
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Which Sheave failed?
- Right upper set
- Left upper set
- Right lower
- Left lower
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Safety Locks
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Which Safety Lock (spring kit)
- Left Side
- Right Side
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Safety Cables
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Cables
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Arms
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Which Arm failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
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Arm Restraints
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Which Arm Restraint failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
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Type of Extension Pad
- Flip up
- RA
- TA
- Drive over
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Extension Pads
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Which ones Fail
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
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Overhead Safety
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All Bolts
Lift
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Are there Runway Extensions?
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Area Cleanliness
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Observe Vehicle on Lift
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Wheel Chocks Present?
Lift Style
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LIFT ASSEMBLY
Inspection
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Airlines
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Safety Locks
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Cables
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Unit Hoses
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Cylinders
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Sliders/Rollers
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Fluid level
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Motor
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Valves
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Yoke Sheaves
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Which Sheave failed?
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
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Runway. Sheaves
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Which Sheave failed?
- Left Front
- Right Front
- Right Rear
- left Rear 4 Stack
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Is the lift Level and Plumb.
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What is the Concern?
- Level
- Pumb
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Electrcal
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All Bolts
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Structure
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Rolling Jacks
Rolling Jacks
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Is there a QR CODE?
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Scan QR CODE!
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Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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Serial Number
Inspection Items
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JACK ASSEMBLY
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What Type of Jack
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Lift Label
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Safety's
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Cylinder's
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Air lines
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Fluid Levels
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Unit Hose
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Wheels
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Pump
-
Sliders
-
Valves
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Adapters
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Lift Label
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Safety's
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Cylinder's
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Air lines
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Wheels
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Valves
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Adapters
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Seals
Inspection
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Airlines
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Safety Locks
-
Cables
-
Unit Hoses
-
Cylinders
-
Sliders/Rollers
-
Fluid level
-
Motor
-
Valves
-
Yoke Sheaves
-
Which Sheave failed?
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Runway Sheaves
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Which Sheave failed?
- 2 Stack
- 4 Stack
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Is the Lift Level and Plumb
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What is the concern?
- Level
- Pumb
-
Electrical
-
All Bolts
-
Structure
-
Rolling Jacks
Rolling Jacks
-
Model
-
Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
-
Serial Number
Inspection Items
-
JACK ASSEMBLY
-
What Type of Jack
-
Lift Label
-
Safety's
-
Cylinder's
-
Air lines
-
Fluid Levels
-
Unit Hose
-
Wheels
-
Pump
-
Sliders
-
Valves
-
Adapters
-
Lift Label
-
Safety's
-
Cylinder's
-
Air lines
-
Wheels
-
Valves
-
Seals
-
Adapters
-
Lift Assembly
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Area Cleanliness
-
Observe Vehicle on Lift
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Hydraulic Lines
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Cylinder's
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Safety Locks
-
Arms
-
Fluid Levels
-
Valves
-
Lift Style
Lift
-
Area Cleanliness
-
Observe Vehicle on Lift
Inspection
-
Airlines
-
Safety Locks
-
Cables
-
Unit Hoses
-
Cylinders
-
Sliders/Rollers
-
Fluid level
-
Motor
-
Valves
-
Is the lift Level and Plumb.
-
What is the Concern?
- Level
- Pumb
-
Electrcal
-
All Bolts
-
Structure
Lift
-
Area Cleanliness
-
Observe Vehicle on Lift
Inspection
-
Airlines
-
Safety Locks
-
Cables
-
Unit Hoses
-
Cylinders
-
Sliders/Rollers
-
Fluid level
-
Motor
-
Valves
-
Is the lift Level and Plumb.
-
What is the Concern?
- Level
- Pumb
-
Electrcal
-
All Bolts
-
Structure
Jacks
-
Is there a QR CODE?
-
Scan QR CODE!
-
Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
-
Serial Number
Inspection Items
-
JACK ASSEMBLY
-
What Type of Jack
-
Lift Label
-
Safety's
-
Cylinder's
-
Air lines
-
Fluid Levels
-
Unit Hose
-
Wheels
-
Pump
-
Sliders
-
Valves
-
Adapters
-
Lift Label
-
Safety's
-
Cylinder's
-
Air lines
-
Wheels
-
Valves
-
Adapters
-
Seals
Lift
-
Lift Assembly
-
Area Cleanliness
-
Observe Vehicle on Lift
-
Is there a Spotting Dish Present
-
Does the Manager want one installed
-
Hoses
-
Which Hose Fails
- Left Cylinder
- Right Cylinder
- Vertical Hose
- Unit Hose
-
Cylinders
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Which Cylinder
- Left Side
- Right Side
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Guide Barrels
-
Guide Barrels (Wipes and Bearings) Greased
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Grease Tubes
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Safety Locks
-
Air Lines
-
Extension Pads
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Type of Extension Pads
- Flip up
- RA
- TA
- Drive over
-
Fluid Level
-
Containment Pit
-
Containment Gasket
-
Bolts
-
Electrical
-
Motor
-
Valves
-
Structure
-
Arms
-
Which Arm failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Arm Restraints
-
Which Arm Restraint failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Extension Pads
-
Which ones Fail
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Type of Lift
Lift
-
Observe Vehicle on Lift
-
Area Cleanliness
-
Is there a Spotting Dish Present
-
Does the Manager want one installed
INSPECTION ITEMS
-
Fluid level
-
Hoses: Please Pick Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
-
Overhead Hoses
-
Unit Hoses
-
Left Cylinder Hose
-
Right Cylinder Hose
-
Unit Hoses
-
Is the Lift Level and Plumb
-
What is the concern?
-
Electrical
-
Lift Label
-
Motor
-
Valves
-
Sliders
-
Cylinders
-
Structure
-
Sheaves
-
Which Sheave failed?
- Right upper set
- Left upper set
- Right lower
- Left lower
-
Safety Locks
-
Which Safety Lock (spring kit)
- Left Side
- Right Side
-
Safety Cables
-
Cables
-
Arm Restraints
-
Which Arm Restraint failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Arms
-
Which Arm failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Extension Pads
-
Which ones Fail
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
-
Overhead Safety
-
All Bolts
Signature and notes
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I, the Store Representative have reviewed the attached Safety Inspection Summary with the Evaluator, and have been advised of the areas where attention is recommended: Store Representative please sign:
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Customer notes:
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Technician Signature:
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Technician notes:
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If you would like any repairs performed please call
John Percy Services LLC
3178 Walden Ave
Depew NY 14043
(716)393-3467 office
(716)601-1303 fax
Email johnpercyservices@gmail.com
