Forklift Inspection Form 4070 Question Title * 1. Lift # Question Title * 2. Inspector Name Question Title * 3. Job Name Question Title * 4. Week Beginning Date Question Title * 5. Any damage or issues? Please walk around the unit and leave a comment regarding any dents/damage you see. MANDATORY - if no damage comment "none" Question Title * 6. Please provide a photo of any damage Question Title * 7. Please provide a second photo of any damage Each forklift 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 forklift deficiencies. Question Title * 8. Operating Controls (Operational) Yes - Functional No - Issues Emergency Stop & Brakes Emergency Stop & Brakes Yes - Functional Emergency Stop & Brakes No - Issues Operation Levers & Controls Operation Levers & Controls Yes - Functional Operation Levers & Controls No - Issues Foot Controls (if applicable) Foot Controls (if applicable) Yes - Functional Foot Controls (if applicable) No - Issues Safety Signs & Load Charts Safety Signs & Load Charts Yes - Functional Safety Signs & Load Charts No - Issues If any maintenance issues, please detail Question Title * 9. Boom & Forks Yes - Functional No - Issues Hydraulic Leaks Hydraulic Leaks Yes - Functional Hydraulic Leaks No - Issues Extension Cylinders & Chains Extension Cylinders & Chains Yes - Functional Extension Cylinders & Chains No - Issues Pivot Pins Pivot Pins Yes - Functional Pivot Pins No - Issues Electrical Lines Electrical Lines Yes - Functional Electrical Lines No - Issues Vert. Mast Sliding & Rolling Parts Vert. Mast Sliding & Rolling Parts Yes - Functional Vert. Mast Sliding & Rolling Parts 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 Lights, Mirrors & Windows Clean Lights, Mirrors & Windows Clean Yes - Functional Lights, Mirrors & Windows Clean No - Issues Seat Belts/Mount Seat Belts/Mount Yes - Functional Seat Belts/Mount No - Issues Tires & Outriggers Tires & Outriggers Yes - Functional Tires & Outriggers No - Issues Back Up Alarm, Horn & Manual Back Up Alarm, Horn & Manual Yes - Functional Back Up Alarm, Horn & 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 forklift Question Title * 14. Please upload a second photo if needed Done
