Title Page

  • Conducted on

  • Prepared by

  • Location
  • Unit Type:

  • If other, type of lift?

  • Lift ID:

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

  • Functional upper drive control interlock (i.e. foot pedal, spring lock or two hand controls) ?

  • Emergency Lowering function operates properly?

  • Lower operating controls successfully override the upper controls?

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

  • Control panel is clean and all buttons/switches are clearly visible (no paint overspray, etc.)?

  • All switch and mechanical guards are in good condition and properly installed?

  • All safety indicator lights work?

  • Drive controls function properly and accurately labeled (up, down, right, left, back)?

  • Motion alarms are functional?

  • Safety decals are in place and readable?

  • All guard rails are sound and in place, including basket chains?

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

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

  • Inspect for defects such as cracked welds, fuel leaks, hydraulic leaks, damaged control cables or wire harness, etc.?

  • Tires and wheels are in good condition, with adequate air pressure if pneumatic?

  • Braking devices are operating properly?

  • The manufacturer’s operations manual is stored on MEWP (in all languages of operators)?

  • Oil level, hydraulic oil level, fuel level, coolant level?

  • Battery charged?

  • Outriggers in place or functioning. Associated alarms working?

  • Personal protection in use (harness, lanyard, hard hat, etc.)?

  • In windy conditions see manufacturers guidelines or if not in guidelines then…if lift begins to rock in the wind, lower the lift.

  • Floor conditions: drop offs, holes, uneven surfaces, and sloped floors?

  • Housekeeping: Debris, floor obstructions, cords, construction material and supplies.

  • Electrical power cables or panels (minimum 10 feet away). If larger lines or wet conditions contact electrical shop for guidance. Insulated small lines in dry conditions, 3 feet away.

  • Chemical lines, gas lines, drain lines and utilities?

  • Overhead obstructions?

  • Loads do not exceed capacity?

  • Watch for vehicular and pedestrian traffic. Set up barricades as necessary.

  • Inspecting person:

  • Verified by:

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.