Powered Mobile Equipment Checklist
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Operator Name
*
Alec Demster
Astrit Martinaj
Ayden Bremner
Ben Peirce
Bernie Clapperton
Christian Wells
Conner Schulhof
Dean
Dirk Risse
Eamonn Walsh
Gary Kennelly
Janos Locz
Joel Edrosolano
Jordan Bergevin
Marko B
Mikey B
Oleksandr Skoropad
Ray Carriere
Roger
Stephen King
Trevor Jones
Willem Kamphorst
Other
Operator Email
*
example@example.com
Work Site
*
ALAIR - 209 Glen Banff
Ashton - 8th and 8th
Ashton - CCH Stewart Creek
Ashton - Meadows
Ashton - Trinity Bible Church
Barjac - Calgary Hyundai
Barjac - Country Hills Kia
Barjac - Wolfe
BECL
Bird - fire cache
Bird - Rundle Park
Bruce - Bow Lake Cabins
Cairo - Ascent
CHANDOS - Canmore Water Plant
Clark builders - Fernie
CRMR - Buffalo MTN Lodge
DMF SHOP
Highpoint - Cascade Canmore GP Ltd
Kalaimor - Brookside 10th Street
Kalaimor - MTN house
SBL - iPlace
SBL - settlers
Stuart Olson - Banff Center
TOB
TOC - Elevation Place
TRAILER AND OFFICE
Type Site Name
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Equipment
*
Lull 944E-42 - telehandler
Lull 1044C-54
Genie 5519 - telehandler
Scissor Lift
Man Basket
Other
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
Comments:
Signature
*
Submit
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