Aerial Lift Inspection Form 4080 Question Title * 1. Lift # Question Title * 2. Inspector Name Question Title * 3. Job Name Question Title * 4. Inspection Date Question Title * 5. Any damage or issues? Please walk around the unit and leave a comment on any damages/dents, etc you can see. MANDATORY - if no damage type 'None' Question Title * 6. Please provide a photo of the damage Question Title * 7. Please provide a second photo of the damage Each aerial lift will be operationally tested and visually inspected on a regular basis. The designated inspector will place a check in the appropriate box when an item passes inspection. Leave the box empty and note a brief description of any problem. Immediately notify the Foreman of any aerial lift deficiencies. Question Title * 8. Operating Controls (Operational) Yes - Functional No - Issues Emergency Stop & Brakes Emergency Stop & Brakes Yes - Functional Emergency Stop & Brakes No - Issues Base Operation Controls Base Operation Controls Yes - Functional Base Operation Controls No - Issues Basket Operation Controls Basket Operation Controls Yes - Functional Basket Operation Controls No - Issues Foot Controls (if applicable) Foot Controls (if applicable) Yes - Functional Foot Controls (if applicable) No - Issues Safety Signs (readable) Safety Signs (readable) Yes - Functional Safety Signs (readable) No - Issues If any maintenance issues, please detail Question Title * 9. Boom Yes - Functional No - Issues Hydraulic Leaks Hydraulic Leaks Yes - Functional Hydraulic Leaks No - Issues Extension Chain & Pivot Pins Extension Chain & Pivot Pins Yes - Functional Extension Chain & Pivot Pins No - Issues Electrical Lines Electrical Lines Yes - Functional Electrical Lines No - Issues Basket Cage and Gate Basket Cage and Gate Yes - Functional Basket Cage and Gate No - Issues Anchorage Points Anchorage Points Yes - Functional Anchorage Points No - Issues If any maintenance issues, please detail Question Title * 10. Base (Visual) Yes - Functional No - Issues Broken, Cracked or Loose parts Broken, Cracked or Loose parts Yes - Functional Broken, Cracked or Loose parts No - Issues Leaks Leaks Yes - Functional Leaks No - Issues Electrical Issues Electrical Issues Yes - Functional Electrical Issues No - Issues Tires & Outriggers Tires & Outriggers Yes - Functional Tires & Outriggers No - Issues Back Up Alarm & Manual Back Up Alarm & Manual Yes - Functional Back Up Alarm & Manual No - Issues If any maintenance issues, please detail Question Title * 11. Engine Compartment (Visual) Yes - Functional No - Issues Oil Level Oil Level Yes - Functional Oil Level No - Issues Fuel Level Fuel Level Yes - Functional Fuel Level No - Issues Belt, Hose & Motor Condition Belt, Hose & Motor Condition Yes - Functional Belt, Hose & Motor Condition No - Issues Battery & Electrical Battery & Electrical Yes - Functional Battery & Electrical No - Issues If any maintenance issues, please detail Question Title * 12. Any additional comments? Question Title * 13. Please upload a photo if there are any issues with the equipment. Question Title * 14. Please upload a second photo if needed Remember, if 2 people are on the lift equipment, regardless of who is the operator, BOTH individuals MUST be certified to use that equipment. Done
