• EQUIPMENT INFORMATION

  • Make and Model Specific (if more than one lift please list all equipment)

PRE-USE INSPECTION

  • Follow the Operator's Daily Checklist

  • Look for damage

  • Including but not limited to: safety devices, air/hydraulic/fuel system for leaks, cable/wiring harnesses for damage, loose/missing parts, tires and wheels, placards/warnings/and control markings, outriggers/stabilizers and other structures, guardrail system, other items as specified in owner’s manual.

  • Document all findings on checklist

SURVEY/INSPECT WORKSITE

  • Including but not limited to: drop-offs or holes, slopes, bumps and floor obstructions, debris, overhead obstructions and electrical hazards, inadequate surface and support to withstand all load forces, wind and weather conditions, presence of bystanders, other unsafe conditions.

  • Verify appropriate wind and weather conditions

  • Checks for overhead obstructions and electrical hazards

  • Checks for ground level obstructions and debris

  • Checks for bystanders

  • Checks for any other unsafe conditions

LOWER CONTROL STATION TEST

  • Completed a proper function test to determine any malfunctions

SAFE ACCESS TO PLATFORM

  • Face the machine and maintains 3 points of contact while entering

USE OF FALL PROTECTION EQUIPMENT

  • Properly put on all correct fall protection

  • Promptly and properly tied off to equipment upon platform access

PLATFORM CONTROL STATION TEST

  • Completed proper function test to determine any malfunctions

SAFE TRAVEL: DRIVE AND CREEP "INCH: FORWARD AND REVERSE"

  • Move approximately 10 feet in a driving mode. Creep approximately 5 feet. Verify unit balance and stability.

TURN LIFT 360 DEGREES IN EACH DIRECTION

  • Minimum disturbance of lift platform. Verify unit balance and stability.

ELEVATE PLATFORM TO WORKING HEIGHT

  • Safe operation including but not limited to: Check to clear nearby personnel, overhead obstructions and electrical hazards

SHUT DOWN MACHINE USING EMERGENCY STOP FUNCTION

  • Locate and use emergency stop function

PARK AND SHUTDOWN MACHINE

  • Park in safe and stable area

  • Properly shut off operator's panel

SAFE DISMOUNT FROM LIFT

  • Face the machine and maintains 3 points of contact while exiting

FINAL SHUTDOWN OF MACHINE

  • Locate and activate "Dead Man or Kill Switch" to shut lift down completely

  • Promptly and properly untie from equipment when exiting platform

  • Based on my evaluation, the operator has ______________________ completed the evaluations and hands-on training.

  • Evaluator Signature

  • Employee being evaluated Signature

  • Employee being evaluated Photo

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.