Powered Mobile Equipment Checklist
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Operator Name
*
Company
*
Please Select
Alpine Overhead Doors
Big Horn Sheet Metal
Bow Valley Safety
Bow-Cor Welding
Canglass
Canmore West Eavestrough
Cascade Mechanical
Competition Concrete
Convergint Technologies
Diamond Fireplaces
Downer Contracting
Dust Be Gone
Enlightened Organizing
Gallant Insulation
Guisti
Hellbent Geothermal
Henry's Electric
Heritage Decking
Iceline Waterproofing
KCP Energy
Legacy kitchens
Lomaw Contracting
Master Pools
McCool Construction YYC
Men in Kilts
Mountain Prism Painting
Northstar Fire Protection
Old West Flooring
Oskar
Peter's Exteriors
Primary Engineering
Prime Drywall
Procat Contracting Ltd.
Rgo
S2S Electric
SCMV - Construction
SCMV - Client Care
SCMV - RV/Maintenance
Set in Stone
Thompson Drilling
Tristar Woodworks
Wayco Electric
Woodpecker European Timber Framing
Work Site
*
500 Railway Ave
Alexander Hotel
Black Swift Lodge
Grey Wolf Lodge
McCaffery
Mountain Lynx Lodge
Multiple Sites
RV
Spring Creek Gate Road Extension
The Franklin Hotel
TMV and MLV
Type Site Name
Are you using your own form and need to upload a copy?
NO
YES
Upload your own equipment inspection record
Take a Picture of your Completed Form
Drag and drop files here
Choose a file
Once you have completed your own inspection form take a picture and attach to this form
Cancel
of
Equipment
*
Case 1845C - Skid steer
Cat 242B - Skid steer
Cat 263D3 - Skid steer
Cat 305 - Excavator
Cat 316F
Cat 320 - Excavator
Cat 321 - Excavator
Cat 336 - Excavator
Cat 433 - Packer
Cat TL 1055 - RTFL
Cat TL 1255C - RFTL
Genie Z45 - Manlift
Genie Z60 - Manlift
Kubota kx161 - Excavator
Other
Equipment OLD
Please Select
Case 1845C - Skid steer
Cat 242B - Skid steer
Cat 263D3 - Skid steer
Cat 320 - Excavator
Cat TL 1055 - zoom boom/telehandler
Genie Z45 - Manlift
Genie Z60 - Manlift
Kubota kx161 - Excavator
Current Hour Meter
1. Pre-Start (Walk-Around) Inspection
*
Rows
Pass / Fail
Notes
Are the operators, safety and responsibilities manuals available?
Pass
Fail
Tire condition (if applicable) and pressure, rim condition, lug nuts tight
Pass
Fail
Boom/Mast condition, pins and retainers, welds, damaged attachments
Pass
Fail
Fuel, oil, hydraulic oil, antifreeze and battery charge levels, daily grease
Pass
Fail
Cab or platform cleanliness, dents or scratches, decals and placards
Pass
Fail
Signs of fluid leaks on engine, hydraulic cylinders, hoses or ground
Pass
Fail
Seat belt, personal harness, lanyard, anchorage points, gates and safety chains
Pass
Fail
Glass, seat, mirrors, doors, compartment covers
Pass
Fail
2. Equipment Running Tests
*
Rows
Pass / Fail
Notes
Ground and platform controls, emergency systems, operate all functions
Pass
Fail
All hydraulic systems and their respective functions
Pass
Fail
Brakes, steering, lights, horn, warning beepers and lights
Pass
Fail
3. Job Site Work Area Inspection
*
Rows
Completed?
Notes
Walk the intended work route, remove hazards and obstructions
Observe ground conditions, pot holes, culverts, soft or unstable zones etc.
Observe weather conditions, wind, rain, snow, ice etc.
Look for power lines, overhead obstructions, personnel and vehicle zones etc.
4. Safe Machine Operation
*
Rows
Yes / No
Notes (If NO provide Details Here)
Have I read and understood the responsibilities, safety and operators manuals?
Yes
No
Have I received authorization to operate this machine?
Yes
No
Do I practice dual 360 degree awareness when operating?
Yes
No
Do I have qualified personnel on site who can help in an emergency situation?
Yes
No
Do I have a functioning communication system at hand?
Yes
No
5. Safe Machine Shut Down and Security
*
Rows
Yes / No
Notes (If NO provide Details Here)
Do I have a safe place to park the machine and secure keys at end of shift
Yes
No
Are lock-out tags available on machine if required?
Yes
No
Is this machine safe and acceptable for operation?
*
YES
NO
Does this machine require maintenance?
*
YES
NO
Are you also using a harness today?
*
YES
NO
Comments:
Signature
*
Submit
Should be Empty: