Powered Mobile Equipment Checklist
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Operator Name
*
Eiffel Group
Your Custom Home
Your General Contractor (YGC)
Max Property Restoration Ltd.
Work Site
*
Max--Montana
Max--Princeton Cityscapes
Max--Rosewood Estates
Max--Stratford on the Park
Max --Riverview Place
Max --Riveside Towers
YCH-345-1-Doherty Residence
YCH-370-5-McCollister
YCH-183-31-8th Floor Demising Wall
YCH-430-1-Fickes Barndominium
YGC-374-15-Montana Gym
YGC-387-4-193 Country Lane Drive
YGC-397-1-Canco Gas Station - Car Wash
YGC-402-1-134 Forge Rd SE Calgary
YGC-447-1-PRAIRIE SOUND CIRCLE
YGC-452-1-Master Bedroom Renovation
YGC--Southcenter Mall
Other
Other Jobsite
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
Once you have completed your own inspection form take a picture and attach to this form
Cancel
of
Equipment
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: