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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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