AERIAL WORK PLATFORM DAILY CHECKLIST

AERIAL WORK PLATFORM DAILY CHECKLIST

Aerial Work Platforms Procedure HSEOP-26-01
By clicking 'Next,' you acknowledge that you have reviewed and understood the key highlights of the HSE Operating Procedures presented

What jobsite are you on?*
Make*
Model*
Unit*
Date*

MonthDayYear
Date
Hour Meter Reading*
Time*

Hour Minutes

AM/PM Option
1. Platform and Guardrails (No loose or missing parts or visible damage, Lock pins in place.)*

GoodDeficientN/A
2. Hose and Cable Guards on Boom (No damage to guards, hoses, or cables. Properly Secured.)*

GoodDeficientN/A
3. Drive Motors and Brake Shields (Securely bolted in place with no leaks or missing hardware.)*

GoodDeficientN/A
4. Drive Hub (No visible damage or evidence of leakage)*

GoodDeficientN/A
5. Tires and Wheels (No cut tires, No leaks, No rim damage, Marks on lug nuts are in line, Tires properly inflated, No missing lug nuts, Lug nuts to be torqued to spec)*

GoodDeficientN/A
6. Frame (No bends, loose or missing hardware, or other damage)*

GoodDeficientN/A
7. Fuel Supply (Adequate fuel, filler cap in place. No damage, leaks, or spills)*

GoodDeficientN/A
8. Power Track (No visible damage to hydraulic or electrical lines)*

GoodDeficientN/A
9. Boom and Pivot Shaft (Must be properly secured and lubricated.)*

GoodDeficientN/A
10. Lift Cylinder (Rod end shaft properly secured)*

GoodDeficientN/A
11. Tie Rods and Linkage (No visible damage, No steering, No loose or missing parts, No cylinder leaks)*

GoodDeficientN/A
12. Engine Oil (Full mark on dipstick with filler cap secured.)*

GoodDeficientN/A
13. Ground Control Panel (Switches should be operable, placard legible. No visible damage.)*

GoodDeficientN/A
14. Counterweight (Should be properly secured.)*

GoodDeficientN/A
15. Engine Oil Filter (Oil in bowl should be clean and pre-cleaner free of dirt.)*

GoodDeficientN/A
16. Battery (Battery should have proper electrolyte level. Cables should be tight with no corrosion.)*

GoodDeficientN/A
17. Hydraulic Oil Level (Should show full on dipstick with all systems shut down and boom stowed.)*

GoodDeficientN/A
18. Hydraulic Oil Filter (Indicator should be a proper position with engine operating at full throttle and oil warmed up.)*

GoodDeficientN/A
19. Turntable and Pinion (No loose or missing hardware or damage, Shows evidence of lubrication.)*

GoodDeficientN/A
20. Boom (No visible damage, Wear pads secure.)*

GoodDeficientN/A
21. Platform Pivots and Cylinders (Pins properly secured with evidence of lubrication, No cylinder leaks.)*

GoodDeficientN/A
22. Platform Control Console (Switches and levers should be properly secured and free to return to the neutral position, No loose or missing parts, No visible damage)*

GoodDeficientN/A
23. Emergency Safety (Override) Switch (Switch must be fully functional at all times)*

GoodDeficientN/A
24. Extending Axles - If so equipped (No evidence of leakage, loose or missing parts, No visible damage, Axle lock pins should be properly installed)*

GoodDeficientN/A
25. Fire Extinguisher (Checked daily, No visible damage, indicator shows full)*

GoodDeficientN/A
26. Operations Manual (Operating manual must be with the equipment)*

GoodDeficientN/A
Note: Check Placards - all placards and instructions on machine should be secure and legible.
If deficiencies were noted, would any of these require you to place a 'do not operate tag' on this piece of equipment?*

YesNo
Comments:
Print First and Last Name*
Company Name*
Signature*
What is your email?*
example@example.com (A copy of your completed permit will be emailed here)
Should be Empty: