Aerial Lift Inspection Form 4080 Question Title * 1. Lift # Question Title * 2. Inspector Name Question Title * 3. Job Name Question Title * 4. Week Beginning Date 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 * 5. Operating Controls (Operational) Mon Tues Wed Thurs Fri Sat Sun Emergency Stop & Brakes Emergency Stop & Brakes Mon Emergency Stop & Brakes Tues Emergency Stop & Brakes Wed Emergency Stop & Brakes Thurs Emergency Stop & Brakes Fri Emergency Stop & Brakes Sat Emergency Stop & Brakes Sun Base Operation Controls Base Operation Controls Mon Base Operation Controls Tues Base Operation Controls Wed Base Operation Controls Thurs Base Operation Controls Fri Base Operation Controls Sat Base Operation Controls Sun Basket Operation Controls Basket Operation Controls Mon Basket Operation Controls Tues Basket Operation Controls Wed Basket Operation Controls Thurs Basket Operation Controls Fri Basket Operation Controls Sat Basket Operation Controls Sun Foot Controls (if applicable) Foot Controls (if applicable) Mon Foot Controls (if applicable) Tues Foot Controls (if applicable) Wed Foot Controls (if applicable) Thurs Foot Controls (if applicable) Fri Foot Controls (if applicable) Sat Foot Controls (if applicable) Sun Safety Signs (readable) Safety Signs (readable) Mon Safety Signs (readable) Tues Safety Signs (readable) Wed Safety Signs (readable) Thurs Safety Signs (readable) Fri Safety Signs (readable) Sat Safety Signs (readable) Sun If any maintenance issues, please detail Question Title * 6. Boom Mon Tues Wed Thurs Fri Sat Sun Hydraulic Leaks Hydraulic Leaks Mon Hydraulic Leaks Tues Hydraulic Leaks Wed Hydraulic Leaks Thurs Hydraulic Leaks Fri Hydraulic Leaks Sat Hydraulic Leaks Sun Extension Chain & Pivot Pins Extension Chain & Pivot Pins Mon Extension Chain & Pivot Pins Tues Extension Chain & Pivot Pins Wed Extension Chain & Pivot Pins Thurs Extension Chain & Pivot Pins Fri Extension Chain & Pivot Pins Sat Extension Chain & Pivot Pins Sun Electrical Lines Electrical Lines Mon Electrical Lines Tues Electrical Lines Wed Electrical Lines Thurs Electrical Lines Fri Electrical Lines Sat Electrical Lines Sun Basket Cage and Gate Basket Cage and Gate Mon Basket Cage and Gate Tues Basket Cage and Gate Wed Basket Cage and Gate Thurs Basket Cage and Gate Fri Basket Cage and Gate Sat Basket Cage and Gate Sun Anchorage Points Anchorage Points Mon Anchorage Points Tues Anchorage Points Wed Anchorage Points Thurs Anchorage Points Fri Anchorage Points Sat Anchorage Points Sun If any maintenance issues, please detail Question Title * 7. Base (Visual) Mon Tues Wed Thurs Fri Sat Sun Broken, Cracked or Loose parts Broken, Cracked or Loose parts Mon Broken, Cracked or Loose parts Tues Broken, Cracked or Loose parts Wed Broken, Cracked or Loose parts Thurs Broken, Cracked or Loose parts Fri Broken, Cracked or Loose parts Sat Broken, Cracked or Loose parts Sun Leaks Leaks Mon Leaks Tues Leaks Wed Leaks Thurs Leaks Fri Leaks Sat Leaks Sun Electrical Issues Electrical Issues Mon Electrical Issues Tues Electrical Issues Wed Electrical Issues Thurs Electrical Issues Fri Electrical Issues Sat Electrical Issues Sun Tires & Outriggers Tires & Outriggers Mon Tires & Outriggers Tues Tires & Outriggers Wed Tires & Outriggers Thurs Tires & Outriggers Fri Tires & Outriggers Sat Tires & Outriggers Sun Back Up Alarm & Manual Back Up Alarm & Manual Mon Back Up Alarm & Manual Tues Back Up Alarm & Manual Wed Back Up Alarm & Manual Thurs Back Up Alarm & Manual Fri Back Up Alarm & Manual Sat Back Up Alarm & Manual Sun If any maintenance issues, please detail Question Title * 8. Engine Compartment (Visual) Mon Tues Wed Thurs Fri Sat Sun Oil Level Oil Level Mon Oil Level Tues Oil Level Wed Oil Level Thurs Oil Level Fri Oil Level Sat Oil Level Sun Fuel Level Fuel Level Mon Fuel Level Tues Fuel Level Wed Fuel Level Thurs Fuel Level Fri Fuel Level Sat Fuel Level Sun Belt, Hose & Motor Condition Belt, Hose & Motor Condition Mon Belt, Hose & Motor Condition Tues Belt, Hose & Motor Condition Wed Belt, Hose & Motor Condition Thurs Belt, Hose & Motor Condition Fri Belt, Hose & Motor Condition Sat Belt, Hose & Motor Condition Sun Battery & Electrical Battery & Electrical Mon Battery & Electrical Tues Battery & Electrical Wed Battery & Electrical Thurs Battery & Electrical Fri Battery & Electrical Sat Battery & Electrical Sun If any maintenance issues, please detail Question Title * 9. Any additional comments? Question Title * 10. Please upload a photo if there are any issues with the equipment. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload a photo if there are any issues with the equipment. Question Title * 11. Please upload a second photo if needed PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File 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
