Powered Mobile Equipment Checklist
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Operator
*
Operator Email
*
example@example.com
Work Site
*
Company
*
Equipment
*
Current Hour Meter
1. Pre-Start (Walk-Around) Inspection
Rows
Pass / Fail
Notes
Are the operators, safety and responsibilities manuals available?
Pass
Fail
N/A
Tire condition (if applicable) and pressure, rim condition, lug nuts tight
Pass
Fail
N/A
Boom/Mast condition, pins and retainers, welds, damaged attachments
Pass
Fail
N/A
Fuel, oil, hydraulic oil, antifreeze and battery charge levels, daily grease
Pass
Fail
N/A
Cab or platform cleanliness, dents or scratches, decals and placards
Pass
Fail
N/A
Signs of fluid leaks on engine, hydraulic cylinders, hoses or ground
Pass
Fail
N/A
Seat belt, personal harness, lanyard, anchorage points, gates and safety chains
Pass
Fail
N/A
Glass, seat, mirrors, doors, compartment covers
Pass
Fail
N/A
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 & Considerations
Walk the intended work route, remove hazards and obstructions
Observe ground conditions, for slope and soil stability
Observe weather conditions, wind, rain, snow, ice that may affect equipment handling
Look for power lines, overhead obstructions, personnel and vehicle zones etc.
Weather conditions in previous 24 hours (make note)
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 way to communicate in an emergency? ie cell-phone
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:
Any other conditions not noted above
Signature
*
By signing this I confirm I have completed the above checks.
Submit
Should be Empty: