• Project:

  • Contractor:

  • Model Number:

  • Date (Week of):

  • Manufacturer:

  • Serial Number:

  • Operator:

Operator's Station

  • 1. Operation Manual

  • 2. Load Chart Legible

  • 3. Seat Belt

  • 4. Parking Brake

  • 5. Gauges Working

  • 6. Horns & Lights

  • 7. Back-Up Alarm

  • 8. Windshield

  • 9. Controls (marked)

  • 10. Load Rating Plate

Overall Machine

  • 1. Tires (cuts & pressure)

  • 2. Overhead Guard

  • 3. Battery Connections

  • 4. Hydraulic oil (leaks)

  • 5. Engine Oil

  • 6. Covers in Place

  • 7. Hoses (cuts)

  • 8. Frame (integrity)

Lifting Operations

  • 1. Engine Runs Smooth

  • 2. Lifting & Lowering

  • 3. Forks (bent/ cracked)

  • 4. mast (bent/ cracked)

  • 5. Cylinders

  • 6. Brakes (smooth)

  • 7. Steering (smooth)

  • 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

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