Mobile Elevated Work Platform Pre-Shift Inspection Form
Aerial Lifts and Scissor Lifts
Department:
*
Please Select
APICC National Services
APICC Regional Services
Garage Door
M Lukas
Milwaukee Scaffold
Nyco
Scaffold Services
Project Name:
*
Project Number:
Inspector Name:
*
First Name
Last Name
Email Address:
Enter an address if you want a copy of the completed form sent to you or another person. Not required.
Inspection Date:
*
-
Month
-
Day
Year
Date
Type of Lift
*
Indoor Scissor Lift
Rough Terrain Scissor Lift
Straight Aerial Lift
Articulating Aerial Lift
Lift Model Number:
*
Operation & Safety Manual Present
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Warning & Instruction Decals Present and Readable
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Capacity & Control Decals Present and Readable
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
All covers and shrouds in place.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Lift and extension cylinder assemblies.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Pivot pins and retainers.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Boom or scissor assembly condition.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Slave level cylinder and retainers.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Master level cylinder.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Electrical wires.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Battery condition and brackets and covers in place.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Battery charger condition and properly wired with ground.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Tire condition, inflation, and lug nuts.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Outriggers / extendable axles.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Gas and hydraulic tank caps.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Turret condition.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Platform rails and cage.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Toe boards and mesh condition.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Control box assembly.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Platform decking.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Platform fall protection anchor points.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Platform mount assembly.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Fire Extinguisher present, charged, and accessible.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Platform is clean of debris and trip hazards.
*
Good
Not Applicable
Needs Repair
Missing / Needs Replacement
Inspector's Signature
Submit
Should be Empty: