Pallet Jack Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Axles

• Axle should not be bent, out-of-round, or show signs of wear.

  Safe

  At Risk

  N/A

Bushings

• Bushings are not cracked, broken, egg-shaped, or noticeably worn from the original size.

  Safe

  At Risk

  N/A

Load Roller

• Load rollers should be free of flat spots, imbedded pieces of metal, cracks, loose tread, and should turn freely.

  Safe

  At Risk

  N/A

Load Roller Brackets

• Brackets are free of cracks or wear.

  Safe

  At Risk

  N/A

Steer Wheels & Axle

• Steer wheels should be free of flat spots, imbedded pieces of metal, cracks, loose tread, and should turn freely.without rubbing the bottom of the traverse.

  Safe

  At Risk

  N/A

Traverse

• The traverse is free of noticeable wear, as well as bolts and other contributing components.

  Safe

  At Risk

  N/A

Push Rods

• Push rods Are free of broken or cracked welds, bends, and out-of-round holes.

  Safe

  At Risk

  N/A

Lifting Link

• Lifting link does not have out-of-round holes, cracks in welds, or bent ears. Contributing components are intact.

  Safe

  At Risk

  N/A

Handle

• Handle is free of cracks and has its structural integrity maintained. Contributing components are intact.

  Safe

  At Risk

  N/A

Hydraulic Unit

• Hydraulic unit does not have any outside oil leaks. Jack is able to raise and lower loads properly. Both forks raise and lower at same pace.

  Safe

  At Risk

  N/A

• **** ANY "AT RISK" FINDING REQUIRES PALLET JACK TO BE TAGGED AND REMOVED FROM SERVICE UNTIL PROBLEM IS CORRECTED ****

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