Information
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Company Name:
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Inspection title (company name followed by the words Lift Inspection)
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Document No.
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Conducted on
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Location
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Manager's Email
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Inspected by
- Andy Silvestri
- John Percy
- Matt Kugler
- Terry Reap
- Tim Horning
- Tim Schmidt
- William Neuman
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Lifting it Right and ANSI Booklet Present
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Lifting it Right and ANSI Booklet Location
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Are Automotive Lift Safety Tip Stickers posted on every lift
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Are all Lifts properly labeled with lift identification numbers
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SEMI-ANNUALLY LIFT INSPECTION
LIFT
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Pick Lift Style
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Lift identification Number
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Lift Model
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Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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What Height Lift?
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Lift Serial Number
INSPECTION ITEMS
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LIFT ASSEMBLY
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Sliders
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Arm Restraints
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Which Arm Restraint failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
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Arms
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Which Arm failed? Please choose
- Left Front
- Right Front
- Left Rear
- Right Rear
- All
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Extension Pads
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Safety Cables
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Safety Locks
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Which Safety Lock (spring kit)
- Left Side
- Right Side
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Cables
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Hoses: Please Pick Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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Overhead Hoses
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Unit Hoses
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Left Cylinder Hose
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Right Cylinder Hose
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Unit Hoses
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Cylinders
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Valves
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Fluid level
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Motor
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Sheaves
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Which Sheave failed?
- Right upper set
- Left upper set
- Right lower
- Left lower
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Overhead Safety
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All Bolts
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Level
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Electrcal
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Lift Label
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Structure
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Observe Vehicle on Lift
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Area Cleanliness
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Lift identification Number
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Lift Model
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Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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Lift Serial Number
INSPECTION ITEMS
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LIFT ASSEMBLY
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Sliders
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Safety Cables
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Safety Locks
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Cables
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Unit Hoses
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Cylinders
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Valves
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Fluid level
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Motor
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Sheaves
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Which Sheave failed?
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All Bolts
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Level
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Electrcal
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Lift Label
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Structure
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Observe Vehicle on Lift
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Area Cleanliness
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Rolling Jacks
Rolling Jacks
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Model
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Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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Jack Identification Number (ALI#)
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Serial Number
Inspection Items
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JACK ASSEMBLY
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Safety's
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Cylinder's
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Air lines
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Fluid Levels
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Unit Hose
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Wheels
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Pump
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Sliders
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Lift identification Number
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Lift Manufacturer
- Rotary
- Forward
- Nussbaum
- Atlas
- Bendpak
- Hunter
- Challenger
- VBM
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LIFT ASSEMBLY
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Valves
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Hydraulic Lines<br>
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Cylinders
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Safety Locks
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Arms
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Fluid level
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Area Cleanliness
Signature and notes
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I, the Store Representative have reviewed the attached Safety Inspection Summary with the Evaluator, and have been advised of the areas where attention is recommended: Store Representative please sign:
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Customer notes:
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Technician Signature:
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Technician notes:
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If you would like any repairs performed please call
John Percy Services LLC
505 B Erie St.
Lancaster NY 14086
(716)393-3467 office
(716)601-1303 fax
Email jpercyservices@gmail.com
