Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Operator trained<br>

  • Add media

  • Manlift on firm level surface<br>

  • Add media

  • Not elevated if wind over 20 mph<br>

  • Add media

  • Platform railing in place and secure<br>

  • Add media

  • Fullbody harness and lanyard attached<br>

  • Add media

  • Firm footing on platform floor.<br>

  • Add media

  • Platform floor free of excess debris.<br>

  • Add media

  • Minimum clearance of 20 feet from overhead electrical lines.<br>

  • Add media

  • Guardrails not used to handle materials.<br>

  • Add media

  • Boom fully retracted & as close to ground as possible when traveling.<br>

  • Add media

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.