Title Page
-
Project:
-
Contractor:
-
Model Number:
-
Date (Week of):
-
Manufacturer:
-
Serial Number:
-
Operator:
Operator's Station
-
1. Operation Manual
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
2. Load Chart Legible
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
3. Seat Belt
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
4. Parking Brake
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
5. Gauges Working
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
6. Horns & Lights
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
7. Back-Up Alarm
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
8. Windshield
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
9. Controls (marked)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
10. Load Rating Plate
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Overall Machine
-
1. Tires (cuts & pressure)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
2. Overhead Guard
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
3. Battery Connections
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
4. Hydraulic oil (leaks)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
5. Engine Oil
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
6. Covers in Place
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
7. Hoses (cuts)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
8. Frame (integrity)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Lifting Operations
-
1. Engine Runs Smooth
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
2. Lifting & Lowering
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
3. Forks (bent/ cracked)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
4. mast (bent/ cracked)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
5. Cylinders
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
6. Brakes (smooth)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
7. Steering (smooth)
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
-
The undersigned certifies that this unit and its accessories have been properly inspected, in due time, that any discrepancy has been brought to the attention of the
owner/user and that all discrepancies have been corrected prior to further use of this unit or its accessories. -
Signature of QUALIFIED USER/OPERATOR
Day
-
Signature
Notes and Comments
-
NAME of QUALIFIED USER/OPERATOR:
-
MOTORIZED UNIT MODEL and SERIAL NUMBER:
-
DATE of INSPECTION:
-
Add notes and comments.
Note/Comment
-
Date Entered
-
Note or Comment
-
Corrective Action Required
-
Date of Report to Owner/User
-
Date of Completion for Corrective Action
-
The undersigned certifies that this unit and its accessories have been properly inspected, in due time, that any discrepancy has been brought to the attention of the
owner/user and that all discrepancies have been corrected prior to further use of this unit or its accessories. -
Name and Signature of QUALIFIED PERSON
-
Date of Inspection
