INBOUND EQUIPMENT PRE-USE SAFETY INSPECTION FORM
This checklist provides a list of items operators must inspect and items they should also be aware of during a pre-use check each day. Operators should record that they’ve completed the check and any issues found.
MaintainX
07/16/2022
INBOUND EQUIPMENT PRE-USE SAFETY INSPECTION FORM
This checklist provides a list of items operators must inspect and items they should also be aware of during a pre-use check each day. Operators should record that they’ve completed the check and any issues found.
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
Leaking Fluids Present
Hydraulic Hoses in Good Condition
Lights and Mirrors
Structural Damage Present
Computer Aids / Operator Controls
Roll Over Protection
Seat Belt Latches Properly
Fire Extinguisher with Current Inspection
Glass Condition
Back Up Alarm / Bi-directional
Kill Switch
Horn
Operator Controls
Labels, Voltage & Hand Signal Chart, e.g.
Wire Rope
Outriggers
Aux. Hook and Ball
Main Hook and Block
Boom / Mask / Cylinders
Anti Two Block
Wedge Socket Plus Cable Length (6 x Diameter)
Brakes
Emergency Flares and Triangles
Fork Lift Assembly Bolts
Operators Manual Present and Load Chart
Record of Last Performed Maintenance
C of C Not Having Counterfeit Material
Periodic Inspection
DOT Annual Inspection
OSHA Annual Inspection (if required)
Generator Circuit Breaker is Open (Off) Position
Generator has no Electrical Primary Feed or Secondary Load Cables Connected
Section 4 – Fuel Type
Fuel Type
Section 5 – Comments
Comments:
Section 6 – Qualified Radiological Control Technician acceptance for equipment receiving (Inbound)
Qualified Radiological Control Technician acceptance for equipment receiving (Inbound)
Print name:
Signature:
Click here to sign
Section 7 –Qualified Person (Leased Equipment Manager)
Qualified Person (Leased Equipment Manager)
Print Name:
Signature:
Click here to sign
Source: MaintainX (Community Member)