LIFT OPERATOR’SDAILY CHECKLIST

Inspection Performed by:LIFT ID #(serial number)

Week beginningRental Co/Equipment Model:

Note: This check must be made by the lift operator daily at the start of the shift. Check (√) the OK box if good, or the repair box for adjustments, givedetails in comment section below. Retain this form for one year.

MONOK REPAIR

Comments: (Items needing repair or adjustment)

Inspection Sequence

9900 Georgia St. Crown Point, IN 46307 Office: (219) 794-1495 Fax: (219)0756-0636

20Project Name: Project Number:

BATTERY

DECALS / NAME PLATE

EMERGENCY STOP & LOWERING FUNCTION

FIRE EXTINGUISHER (DATE / CHARGE)

FLUID LEVELS

Caution - If the lift is found to be in need or repair or in any way unsafe, or contributes to an unsafe condition, the matter shall be reported immediately to thedesignated authority, and the lift shall not be used until it has been restored to a safe operating condition. If during operation, the lift becomes unsafe in anyway, the matter shall be reported immediately to the designated authority, and the lift shall not be used until it has been restored to safe operating condition.Do not make repairs or adjustments unless specifically authorized to do so.

GUARD RAILS

HYDRAULIC CONTROLS / HOSES

LIGHTS, WARNING

TUESOK REPAIR

WEDOK REPAIR

THURSOK REPAIR

FRIOK REPAIR

SATOK REPAIR

SUNOK REPAIR

MOTION ARMS

OBVIOUS DAMAGE

STEERING

TIRES

DROP OFFS - Holes, platform edges, slopes, debrisincluding tools, equipment, materials

INSPECTING PERSON’S INITIALS - I have checked andverified to the best of my knowledge that everything is ina safe and proper working condition

OVERHEAD CLEARANCES - Pipes, beams, power lines