MEWP Pre-Shift Inspection UNCH

MEWP Pre-Shift Inspection

UNCH Surgical Tower
Date:*
Type of MEWP*

Scissor LiftBoom LiftOne Person Lift
Responsible Contractor
Company Name
Other Company
Unit ID*
Equipment Number
Operator Name:*

First NameLast Name
Supervisor Name*

First NameLast Name
Occupant Name (If Applicable)

First NameLast Name
Are the operator and occupants properly trained and familiar with the equipment?

PassFailN/A
Surface Conditions (holes, platform edges, slopes)

PassFailN/A
Housekeeping

PassFailN/A
Weather (Wind/Lightning)

PassFailN/A
Overhead Obstructions

PassFailN/A
Operators Manual in Machine

PassFailN/A
Entry Gate (Not Damaged)

PassFailN/A
Battery

PassFailN/A
Decals/Name Plate

PassFailN/A
Emergency Stop/Lowering Function

PassFailN/A
Fire Extinguisher (Date/Charged/Condition)

PassFailN/A
Fluid Levels

PassFailN/A
Guard Rails

PassFailN/A
Battery

PassFailN/A
Hydraulic Controls/Hoses

PassFailN/A
Lights/Warning

PassFailN/A
Motion Alarms

PassFailN/A
Obvious Damage (Cracks in Rails, Dents, Excessive Rust, etc.)

PassFailN/A
Steering

PassFailN/A
Tires

PassFailN/A
Anti-Crush Device

PassFailN/A
Fall Protection Equipment / Attachments

PassFailN/A
Function Test Completed (Ground controls, platform controls, decal inspection)

PassFailN/A
Other (Describe in Comments)
Signature*

Clear
EHS Manual Forms - Aerial Work Platform Inspection Rev 2 OCT 2017
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