Heavy Equipment/Fork Lift Inspection
UNCH Surgical Tower
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Minutes
AM
PM
AM/PM Option
Inspector:
*
First Name
Last Name
Foreman:
*
First Name
Last Name
Unit Number:
*
Responsible Contractor
Alpha Insulation & Waterproofing, Inc.
ASPE-South LLC
Aurora
Bailey Contracting, Inc.
Bernhard (NC)
Briegan Concrete LLC
Carolina Conduit Systems, Inc.
Central Concrete
CFE Roofing
CLEVE WAGSTAFF STONE MASONRY LLC
D.H. Griffin
David Allen Company
Dickerson Fencing Co., Inc.
Eastern Corporation
Faulconer Construction Company, Inc.
Fire & Life Safety America, Inc.
Growth Management Services Inc
Johnson Controls Fire Protection
K & R Building Solution
Keller Drilling
Manganaro Southeast LLC (NC)
McKinney Drilling
New England Tech Air
OTIS Elevator
Pipeline
Precision Walls
Pyramid Masonry Contractors
QC Commercial
Siemens
Skanska USA Building Inc. (NC)
Smith Metals
Southern Elite Steel
Specialty Construction Services, Inc
SPS Corporation
Subsurface Construction Company LLC
Young
Other Company
Tires:
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
NO EXCESSIVE WEAR, SPLITTING OR MISSING TIRE MATERIAL
GOOD RIM CONDITION
TIGHT WHEEL NUTS
NO SEPARATION OF RUBBER AND RIM
PROPER TIRE PRESSURE (IF PNEUMATIC TIRES ARE USED)
PROPER TIRES USED FOR FORKLIFT AND SURFACES
BATTERY POWERED FORKLIFTS
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
BATTERY MOUNTED SECURELY
BATTERY CASING IN GOOD SHAPE
ALL CONNECTIONS SECURE
PROPER FUEL LEVEL
VENT HOLES ARE CLEAR
GAS, PROPANE, OR DEISEL POWERED FORKLIFTS
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
FUEL TANKS HAVE NO CRACKS, BROKEN WELDS, OR OTHER DAMAGE
ALL VALVES AND COUPLINGS OK
MOUNTING HARDWARE SECURE
FORKS
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
FORKS ARE CENTERED ON CARRIAGE
FORKS HAVE NO CRACKS OR OTHER DAMAGE
FORKS ARE EQUALLY SPACED
FORKS ARE RIGHT FOR THE JOB
LOCKING PINS WORK CORRECTLY
GAUGES
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
ALL GAUGES WORK PROPERLY
ALL INDICATORS WORK PROPERLY
MOVING PARTS WORK SMOOTHLY AND PROPERLY
MAST AND LIFT CYLINDERS
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
LIFT CARRIAGE TO MAXIMUM HEIGHT
LOWER CARRIAGE TO JUST ABOVE GROUND
CARRIAGE MOVES SMOOTHLY AND COMPLETELY
CYLINDERS AND HYDRAULIC LINES
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
HYDRAULIC FLUID AT PROPER LEVELS
NO DAMAGE TO OR FLUID LEAKING FROM LIFT & TILT CYLINDERS
MOUNTING HARDWARE ON CYLINDERS IS SECURE
HYDRAULIC LINES ARE OK
SECURE CONNECTIONS AT FITTINGS
PARKING BRAKE
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
SET PARKING BRAKE AND ACCELERATE -PARKING BRAKE PREVENTS THE FORKLIFT FROM MOVING
ACCELERATOR, TRANSMISSION, AND SERVICE BRAKES
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
FORKLIFT ACCELERATES SMOOTHLY
BRAKES SLOW FORKLIFT WITHOUT JERKING OR LOCKING
BRAKE PEDAL FEELS SOFT
FORKLIFT MOVES FORWARD PROPERLY
FORKLIFT MOVES BACKWARD PROPERLY
BACKUP SIGNAL SOUNDS WHEN IN REVERSE
CHAINS
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
ENGINE HAS NO LOOSE OR FRAYED WIRING
AIR FILTER OK
OIL FILTER OK
PROPER OIL LEVEL
TRANSMISSION FLUID OK
RADIATIOR FLUID OK
CARRIAGE MAST AND BACKREST
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
NO VISIBLE DAMAGE
SECURE MOUNTINGS
NO BROKEN WELDS
ROLLER TRACKS ARE LUBRICATED
GUARDS
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
NO BROKEN WELDS
MOUNTED SECURELY
NO VISIBLE DAMAGE
STEERING
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
STEERING WHEEL TURNS WHILE STOPPED
STEERING WHEEL TURNS WHILE MOVING
STEERING WHEEL TURNS FORKLIFT SMOOTHLY AND PRECISELY
NO STRANGE NOISE
NO HESITATION
IDENTIFICATION PLATE AND OPERATORS MANUAL
*
OK/GOOD / PASS
NO GOOD/ FAIL
NOT APPLICABLE
IDENTIFICATION PLATE IS READABLE
OPERATORS MANUAL IS ON FORKLIFT
FORKLIFT IS SAFE TO OPERATE: SIGNATURE
*
SIGN HERE
Submit
EHS Manual Forms - Forklift Inspection Rev 1 Feb.2016
Should be Empty: