AERIAL WORK PLATFORM DAILY CHECKLIST
Aerial Work Platforms Procedure HSEOP-26-01
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New Waterford Hub
Northside Health Complex
South Shore Regional Hospital
DCC Land Base
Ecole Halifax Peninsule
DCC 4ESR
DCC Ground Base
CRA Saint John Fit-up
Transition Centre
PEI Mental Health & Addictions
Yarmouth Regional Hospital
RK MacDonald Nursing Home
Timberlea PP-8 School
CMMA Aircraft Maintenance
DCC D-20 Secure Room
DCC S32 Heritage Envelop Repairs
SMU Cafeteria -Gluten Free
New Atlantic District Office
CUPE- St. Johns Office Relocation
QEII HVAC Upgrade
Testing
Make
*
Model
*
Unit
*
Date
*
-
Month
-
Day
Year
Date
Hour Meter Reading
*
Time
*
Hour Minutes
AM
PM
AM/PM Option
1. Platform and Guardrails (No loose or missing parts or visible damage, Lock pins in place.)
*
Good
Deficient
N/A
2. Hose and Cable Guards on Boom (No damage to guards, hoses, or cables. Properly Secured.)
*
Good
Deficient
N/A
3. Drive Motors and Brake Shields (Securely bolted in place with no leaks or missing hardware.)
*
Good
Deficient
N/A
4. Drive Hub (No visible damage or evidence of leakage)
*
Good
Deficient
N/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)
*
Good
Deficient
N/A
6. Frame (No bends, loose or missing hardware, or other damage)
*
Good
Deficient
N/A
7. Fuel Supply (Adequate fuel, filler cap in place. No damage, leaks, or spills)
*
Good
Deficient
N/A
8. Power Track (No visible damage to hydraulic or electrical lines)
*
Good
Deficient
N/A
9. Boom and Pivot Shaft (Must be properly secured and lubricated.)
*
Good
Deficient
N/A
10. Lift Cylinder (Rod end shaft properly secured)
*
Good
Deficient
N/A
11. Tie Rods and Linkage (No visible damage, No steering, No loose or missing parts, No cylinder leaks)
*
Good
Deficient
N/A
12. Engine Oil (Full mark on dipstick with filler cap secured.)
*
Good
Deficient
N/A
13. Ground Control Panel (Switches should be operable, placard legible. No visible damage.)
*
Good
Deficient
N/A
14. Counterweight (Should be properly secured.)
*
Good
Deficient
N/A
15. Engine Oil Filter (Oil in bowl should be clean and pre-cleaner free of dirt.)
*
Good
Deficient
N/A
16. Battery (Battery should have proper electrolyte level. Cables should be tight with no corrosion.)
*
Good
Deficient
N/A
17. Hydraulic Oil Level (Should show full on dipstick with all systems shut down and boom stowed.)
*
Good
Deficient
N/A
18. Hydraulic Oil Filter (Indicator should be a proper position with engine operating at full throttle and oil warmed up.)
*
Good
Deficient
N/A
19. Turntable and Pinion (No loose or missing hardware or damage, Shows evidence of lubrication.)
*
Good
Deficient
N/A
20. Boom (No visible damage, Wear pads secure.)
*
Good
Deficient
N/A
21. Platform Pivots and Cylinders (Pins properly secured with evidence of lubrication, No cylinder leaks.)
*
Good
Deficient
N/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)
*
Good
Deficient
N/A
23. Emergency Safety (Override) Switch (Switch must be fully functional at all times)
*
Good
Deficient
N/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)
*
Good
Deficient
N/A
25. Fire Extinguisher (Checked daily, No visible damage, indicator shows full)
*
Good
Deficient
N/A
26. Operations Manual (Operating manual must be with the equipment)
*
Good
Deficient
N/A
Note: Check Placards -
all placards and instructions on machine should be secure and legible.
Comments:
Print First and Last Name
*
Signature
*
What is your email?
*
example@example.com (A copy of your completed permit will be emailed here)
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