Scissor Lift / Boom Inspection

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Operator

Main Info

• Serial Number

General info

• Are you trained and authorized to use this lift?

  Yes

  No

  N/A

• Tires in good conditions

  Yes

  No

  N/A

• Lug nuts on the wheel tight

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Presence of fire extinguishers

  Yes

  No

  N/A

• Beams stability

  Yes

  No

  N/A

• Platform: Absent of loose or missing pieces

  Yes

  No

  N/A

• Platform: Do the controls function properly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Work site inspection

• Absent of any structural damages

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Absent of grease and/or dirt

  Yes

  No

  N/A

• Absent of overhead wires or other obstructions<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Guardrail

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

  Yes

  No

  N/A

• Is the gate/chain functioning properly

  Yes

  No

  N/A

Fall prevention

• Floor anchors available

  Yes

  No

  N/A

Information

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

  Yes

  No

  N/A

• Is the operators Manual and ANSI Standards on the machine

  Yes

  No

  N/A

Mechanic

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

  Yes

  No

  N/A

• Absent of air, hydraulic, or fuel leaks

  Yes

  No

  N/A

• Are the wires to the control box covered and secure

  Yes

  No

  N/A

Checking operations

• Horn

  Yes

  No

  N/A

• Headlights/rotary headlights

  Yes

  No

  N/A

• Warning lights and sounds

  Yes

  No

  N/A

• Ground operating controls

  Yes

  No

  N/A

• Emergency control functions from ground

  Yes

  No

  N/A

• Platform: Do the controls function properly?

  Yes

  No

  N/A

• Brakes working properly<br>

  Yes

  No

  N/A

OVERALL DISPOSITION

• Lift is approved for use at time of inspection

  Yes

  No

  N/A