Aerial Manlift Usage Safety Inspection
Site
Date/Time
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
24-Hour Time Minutes
Safety Inspector
First Name
Last Name
Foreman/Lead
First Name
Last Name
Machine #1 Operator
First Name
Last Name
Machine #1
Machine #2 Operator
First Name
Last Name
Machine #2
Machine #3 Operator
First Name
Last Name
Machine #3
Job Safety Briefing performed for the crew?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Job Hazard Analysis performed?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Does the JHA Process Form match the work?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Is the JHA Form complete and with hazards and mitigation?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Aerial Manlift Operator has Competency?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Spotter used when manlift is maneuvering?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Aerial Manlift has daily inspection completed?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Aerial Manlift maneuver area clear?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Aerial Manlift occupants have PFAS?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Total load does not exceed rating?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Outriggers, if appropriate, are properly set?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Drilling does not discharge dust into breathing zone?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Cable trays are properly braced during attachment?
*
Acceptable
Marginal
Unacceptable
N/A
N/O
Submit
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