Scissor/Boom pre-use checklist hsf6.8

• Revision

• This form is equivalent to Tyco form HSF 6.8 this is an electronic issue 1.0 21/09/16

• Branch / Location
  Address
• Site Address
  Address

• Inspected By

• Conducted on

  Date

• Operators Name

• Payroll Number

• Operators IPAF no

• IPAF Expiry Date

  Date

• Do you have correct license (Trailer Scissor lift 1a 1a+) (Vehicle Trailer Boom 1b 1b+) (MEWP 3a 3a+)

  Yes

  No

  N/A

• Model Number

• Fuel Type

  Diesel

  Electric

• Plant hire type

  Static Vertical (Trailer Scissor)

  Mobile Boom (MEWP)

  Static Boom (Vehicle Mounted)

  Mobile Boom (Cherry Picker)

• Serial Number

• Working Height

Documentation

• Is Examination Certificate Valid Within The Last 6 months

  Yes

  No

  N/A

• Is the Manufatures Operations Manual Stored On The Scissor Boom

  Yes

  No

  N/A

Signage

• Are saftey decals In place and readable

  Yes

  No

  N/A

• Control Panel is clean & all buttons/switches are clearly visible (no paint etc.)

  Yes

  No

  N/A

• Platform loads safe working load, max workings

  Yes

  No

  N/A

• All switch & mechanical Guards are in good condition and properly installed

  Yes

  No

  N/A

Platform Or Cage

• All guardrails are sound and in place, including basket chains,gates & door

  Yes

  No

  N/A

• Work platform & extension slides are clean, dry, & clear of debris

  Yes

  No

  N/A

• Work platform extension slides in and out freely with safety locking pins in place to lock setting on models with extension platforms.

  Yes

  No

  N/A

• Steps for access egress secure, undamaged and clear

  Yes

  No

  N/A

Wheels And Tyres

• Tyres and wheels are in good condition, without cuts, splits exposed braiding and damaged rims.

  Yes

  No

  N/A

• Wheel nuts, retainers loose, damaged, & missing.

  Yes

  No

  N/A

• Tyre pressure adequate if pneumatic.

  Yes

  No

  N/A

Hydraulics

• Check hydraulic fluid level

  Yes

  No

  N/A

• Inspected for hydraulic leaks (pipe connections, rams & cylinders)

  Yes

  No

  N/A

Power / Engine

• Inspect the Battery including charging plug and connections

  Yes

  No

  N/A

• Check engine fluid levels and any fluid leaks

  Yes

  No

  N/A

Structure

• Inspect for defects such as cracked welds, damaged control cables or wire harness, etc

  Yes

  No

  N/A

• Braking devices are operating properly

  Yes

  No

  N/A

• Canopies guards engine covers fully secure and in good condition.

  Yes

  No

  N/A

Function Checks

• Operating and emergency controls are in proper working condition, EMO button, or Emergency Stop.

  Yes

  No

  N/A

• Are all the outriggers in place and function as per the manufactures instructions

  Yes

  No

  N/A

• Both upper and lower controls are adequately protected from inadvertent operation.

  Yes

  No

  N/A

• Drive controls function properly & are accurately labelled (up, down, right, left, forward, back) and move freely without sticking

  Yes

  No

  N/A

• Upper drive controls interlock mechanism is functional (i.e. foot pedal, spring lock, or two hand controls).

  Yes

  No

  N/A

• Lower operating controls successfully over ride the upper controls.

  Yes

  No

  N/A

• Emergency lowering function operates properly.

  Yes

  No

  N/A

• Motion alarms are functional.

  Yes

  No

  N/A

• All safety indicator lights work.

  Yes

  No

  N/A

Tool Tethers

• If applicable: Clean, free from tears, abrasion, scorch marks, oil and paint etc?

  Yes

  No

  N/A

• WORKPLACE ASSESSMENT: Survey work area for potential hazards operating conditions prior to Scissor / Boom Usage. Ensure hazards identified are addressed or during pre-task planning process with sufficient strategies to mitigate the hazards or risks

• ground conditions

  Safe

  At Risk

  N/A

• Floor Obstructions

  Safe

  At Risk

  N/A

• Overhead Hazardous

  Safe

  At Risk

  N/A

• Overhead Obstructions

  Safe

  At Risk

  N/A

• signed

  Sign

• ALL FAULTS AND DEFECTS TO BE REPORTED IMMEDIATELY TO YOUR SUPERVISOR

• Only persons who are trained and authorised must operate this equipment
  DO NOT OPERATE ANY MACHINE THAT IS IN AN UNSAFE CONDITION