Safety Matters - Scissor Lift Inspection Form

• Prepared by

• Conducted on

  Date

• Site conducted

• Job number

• Equipment Make and Model

• Serial/Equipment Number

External Inspection

• Frame and structure appear in good order, no cracked welds or bent rails

  Yes

  No

  N/A

• All fasteners, pins, and connectors in place and secured

  Yes

  No

  N/A

• Tires appear in good order, no excessive wear or missing tread

  Yes

  No

  N/A

• All decals in place and legible

  Yes

  No

  N/A

• Are there visible hydraulic leaks

  Yes

  No

  N/A

• Fall protection devices in place (rails, gates/chain, tie-off points, etc.)

  Yes

  No

  N/A

• All electrical components and wiring in good condition

  Yes

  No

  N/A

• All hoses and connections in good condition

  Yes

  No

  N/A

• Battery and terminals in good condition

  Yes

  No

  N/A

Operational Inspection

• Operation Light, Alarms and Horn Operational

  Yes

  No

  N/A

• All operational controls work (ground controls and basket controls)

  Yes

  No

  N/A

Additional Items

• Does vehicle meet Safe Use Standards?

  Yes

  No

  N/A

• Additional Comments

• Operator Signature

  Sign