Aerial Lift Pre-Use Inspection Record Date Aerial Lift ID Unit Type ☐ Scissor Lift ☐ Boom Lift Shift Site (FFD, MKE, WC etc.) ☐ Other; please list: INSPECTION OK or Yes Battery / Fuel Battery is correctly charged and not leaking Battery cables and connectors in good working condition Fuel level is at adequate level No unusual smells or vapors Tires and Wheels No gouges, chunking or flat spots Adequate tread Chassis Oil level at acceptable level Hydraulic level at acceptable level Fuel level at acceptable level No damage to hoses or connectors No leaks from hoses or connectors (check under lift) Ground control switches are functional Functional Horn is operational All gauges are operational Brakes are operational Steering is smooth and operational All lights are operational Alarms (driving, lifting, backing etc.) operational Platform / Basket Platform controls are functional Operators Manual present Guardrails, handrails and safety chains are in place and not damaged Platform deck is clean with no hazards Worksite Winds are at acceptable levels (check manufacturers guidelines) Pedestrian / traffic has been adequately barricaded Working surface is level Electrical lines have been identified Load limits have been identified Other (List below) NO or Defective N/A ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Comments: Any mark in the “No or defective” column indicates an unsafe condition. DO NOT OPERATE THIS AERIAL LIFT IF AN UNSAFE CONDITON IS IDENTIFIED. REMOVE THE KEY, TAG OUT THE LIFT AND REPORT THE PROBLEM TO YOUR SUPERVISOR IMMEDIATELY. Operators Name (printed) Signature Completed form to be returned to your supervisor for retention.
