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OUTBOUND EQUIPMENT PRE-USE SAFETY INSPECTION FORM

This pre-use inspection checklist form intends to identify defects and safety hazards before operation. The main aim of a pre-start checklist inspection is to ensure that your equipment is safe to use.
MaintainX
07/16/2022

OUTBOUND EQUIPMENT PRE-USE SAFETY INSPECTION FORM

This pre-use inspection checklist form intends to identify defects and safety hazards before operation. The main aim of a pre-start checklist inspection is to ensure that your equipment is safe to use.

    Section 1 – Inspection Performed by Qualified Personnel Only

  • Location / Project

  • Equipment Inspected By

  • Date

  • Contractor

  • Section 2 – Check Type of Equipment Inspecting

  • Type of Equipment

  • Manufacturer

  • Model Number

  • Serial Number

  • Contact Name

  • Contact Phone

  • Section 3 – General Categories to Inspect

  • Tires / Tracks / Drive Chains

    • Pass
    • Flag
    • Fail
  • Leaking Fluids Present

    • Pass
    • Flag
    • Fail
  • Hydraulic Hoses in Good Condition

    • Pass
    • Flag
    • Fail
  • Lights and Mirrors

    • Pass
    • Flag
    • Fail
  • Structural Damage Present

    • Pass
    • Flag
    • Fail
  • Computer Aids / Operator Controls

    • Pass
    • Flag
    • Fail
  • Roll Over Protection

    • Pass
    • Flag
    • Fail
  • Seat Belt Latches Properly

    • Pass
    • Flag
    • Fail
  • Fire Extinguisher with Current Inspection

    • Pass
    • Flag
    • Fail
  • Glass Condition

    • Pass
    • Flag
    • Fail
  • Back Up Alarm / Bi-directional

    • Pass
    • Flag
    • Fail
  • Kill Switch

    • Pass
    • Flag
    • Fail
  • Horn

    • Pass
    • Flag
    • Fail
  • Operator Controls

    • Pass
    • Flag
    • Fail
  • Labels, Voltage & Hand Signal Chart, e.g.

    • Pass
    • Flag
    • Fail
  • Wire Rope

    • Pass
    • Flag
    • Fail
  • Outriggers

    • Pass
    • Flag
    • Fail
  • Aux. Hook and Ball

    • Pass
    • Flag
    • Fail
  • Main Hook and Block

    • Pass
    • Flag
    • Fail
  • Boom / Mask / Cylinders

    • Pass
    • Flag
    • Fail
  • Anti Two Block

    • Pass
    • Flag
    • Fail
  • Wedge Socket Plus Cable Length (6 x Diameter)

    • Pass
    • Flag
    • Fail
  • Brakes

    • Pass
    • Flag
    • Fail
  • Emergency Flares and Triangles

    • Pass
    • Flag
    • Fail
  • Fork Lift Assembly Bolts

    • Pass
    • Flag
    • Fail
  • Operators Manual Present and Load Chart

    • Pass
    • Flag
    • Fail
  • Record of Last Performed Maintenance

    • Pass
    • Flag
    • Fail
  • C of C Not Having Counterfeit Material

    • Pass
    • Flag
    • Fail
  • Periodic Inspection

    • Pass
    • Flag
    • Fail
  • DOT Annual Inspection

    • Pass
    • Flag
    • Fail
  • OSHA Annual Inspection (if required)

    • Pass
    • Flag
    • Fail
  • Generator Circuit Breaker is Open (Off) Position

    • Pass
    • Flag
    • Fail
  • Generator has no Electrical Primary Feed or Secondary Load Cables Connected

    • Pass
    • Flag
    • Fail
  • Section 4 – Fuel Type

  • Fuel Type

  • Section 5 – Comments

  • Comments:

  • Section 6 – Leased Equipment Manager

  • Leased Equipment Manager

    • Yes
    • No
    • N / A
  • Print name:

  • Signature:

    Click here to sign
Source: MaintainX (Community Member)

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