• Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Operator

Main Info

  • Serial Number

General info

  • Are you trained and authorized to use this lift?

  • Tires in good conditions

  • Lug nuts on the wheel tight

  • Has all PPE been acquired, inspected and working properly?

  • Presence of fire extinguishers

  • Beams stability

  • Platform: Absent of loose or missing pieces

  • Platform: Do the controls function properly?

  • Platform: Does the extending Platform move freely on scissor lift?<br>

Work site inspection

  • Absent of any structural damages

  • Absent of holes, drop offs, or soft spot in your work path

  • Absent of any debris that will hinder your work<br>

  • Absent of grease and/or dirt

  • Absent of overhead wires or other obstructions<br>

  • Absent of electrical, telephone, or cable boxes on the ground<br><br>

  • Is the environment suitable for planned work? (wind, rain, mud, ice, lightning)<br>

  • Is the work surface able to support the lift<br>


  • Is the guardrail system in good condition all around the lift

  • Is the gate/chain functioning properly

Fall prevention

  • Floor anchors available


  • Plates, danger and warning labels that are clean and readable

  • Is the operators Manual and ANSI Standards on the machine


  • Fluids levels correct ( fuel, engine, oil, coolant)

  • Absent of air, hydraulic, or fuel leaks

  • Are the wires to the control box covered and secure

Checking operations

  • Horn

  • Headlights/rotary headlights

  • Warning lights and sounds

  • Ground operating controls

  • Emergency control functions from ground

  • Platform: Do the controls function properly?

  • Brakes working properly<br>


  • Lift is approved for use at time of inspection

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.