AERIAL PLATFORM INSPECTION REPORT

Page-01
Name of Supplier : ………….………………………………………………… Date :
………………………………………………………
JLG serial No. Identification No.

MAN LIFT DETAILS STATUS MAN LIFT DETAILS STATUS

1 MAKE : 12 OPERATORS NAME
2 TYPE: 13 INDUCTION BOOK NUMBER
3 BOOM SECTION 14 LICENCE APPLICA
4 WORKING HEIGHT 15 LICENCE NUMBER
5 MAXM. LIFTING CAPACITY 16 LICENCE VALIDITY :

6 REGISTRATION No./ I.D.No. 17 OPERATING EXPERIENCE

7 REGISTRATION BOOK / SERIAL No. 18 SPARK ARRESTOR ( Mandatory )
8 ROAD TAX VALIDITY 19 FIRE EXTINGUSHER ( Mandatory ) 5Kg
9 INSURANCE VALIDITY 20 FIRST AID BOX ( Mandatory )

10 LOAD CHART 21 MAXM. TRAVELLING SPEED

11 LOAD TEST CERTIFICATE- 3rd. Party 22 BOOM RESTING SUPPORT
* ALL CONTROL- FROM MACHINE AND WORK PLATFORM / BASKET ( BOTH PLACES )

* EMERGENCY WIND OFF FROM MACHINE / WORK PLATFORM / BASKET ( BOTH PLACES )
COLOR CODE STICKER : ISSUED REASONS FOR NOT ISSUING STICKERS :
1
NOT ISSUED 2
3
Sign. Of Client
Representative Sign. of Vendor & Stamped

AERIAL PLATFORM CHECK LIST

SL. SYSTEMS STATUS FINDINGS Page-02
1 ENGINE
2 HYDROSTATIC TRANSMISSION
3 REVERSE GEAR ALARM
4 BRAKES FRONT
5 BRAKES REAR
6 PARKING / HAND BRAKES
7 STEERING SYSTEM
8 MAIN BOOM
9 BOOM EXTN
10 LEAKAGES , FROM HYDRAULIC SYSTEM
11 SAFETY INCASE OF HYD. LINE BRUST
12 CONDITION OF HYDRAULIC HOSES
13 COMPLETE HYD. SYSTEM CUTOFF
14 OVER LIFT CUTOFF & ALARM
15 OVER LOAD CUTOFF & ALARM
16 ROTATING LIGHT & BUZZER FOR WORKING
17 SLEWING ALARM BOTH SIDE " LH & RH "
18 HORN
19 ELECTRICAL WIRING & CONNECTORS
20 CONDITION OF TYRES
21 CONDITION OF MAN CARRY BASKET
22 DOOR LOCK FOR MAN CARRY BASKET
23 INSTRUMENTS ON DASH BOARD
REMARKS :
Sign. Of Rep. Sign. of Vendor
DAILY CHECK LIST - ARIAL PLATFORM
Man Lift Hired from : M/s ………………….……………………………….
Present Location : ………………….…
Name of Operator : ……………………
Licence No :………………………………… Induction Book No. :…………………
Make of Man Lift : Make of Engine :
3rd. Party Certificate Validity : Man Lift Code No.:
Report Week : From to
Sl PARTICULARS Date REMARKS
No. Days MON TUE WED THU FRI SAT SUN
1 Lub Oil Level , Engine sump
2 Water level in Radiator
3 Exhaust Gas Color / Noise
4 Spark Arrestor
5 Condition of Fan Belt
6 Engine Oil Pressure
7 Emergency Shutt off of Engine
8 Leakage of Fuel & Lub. oils
9 Leakage of Water
10 Reverse Gear Alarm
11 Leakages of Hydraulic Oil
12 Condition of Hyd. Hoses
13 Wiring Condition & Rooting
14 Battery Circuit Properly Earthed
15 Battery Condition
16 Basket Doors Close & Secure
17 All Controls from Basket
18 All Controls from Ground
19 Emergency Wind Off
20 Fire Extinguisher-5Kg
21 First Aid Box
22 Machine Condition
23 Signature of Operator
24 Signature of Supervisor
Remarks :
RAJASTHAN NORTHERN AREA DEVELOPMENT PROJECT
INITIAL / MONTHLY AERIAL LIFT INSPECTION Accepted
Date of /
RECORD Rejected
inspection: /
Name of Company: /
Type of Equipment: Equipment Model & I.D. No.:
Description OK Damage N/A Remarks
Silencer/Exhaust Noise/Fumes
Fuel leakage
Oil leakage
Untidy Wiring
Tires correctly inflated
Tires free of damage effecting safe operation
Battery cables connection clean/secure
Battery properly secured
Maximum SWL – Number of people sign posted
Fire extinguisher secured into position in basket
Basket clean and free of surplus materials
Guardrails complete and effective/undamaged
Gate closes and secures in closed position
Ground based emergency controls operational
Ground controls return to neutral upon release
Lever movement label clear and legible
Lever handle complete with knob.
Basket controls return to neutral upon release
Control lever hand guard
Dead-man control operational
Safety harness anchor point effective
Equipment logbook located with machine
Hydraulic movement of Basket – smooth
Brake of Basket movement smooth/effective
Basket pivot points free of excessive wear
Pivot pins secured into position
Movement alarm operational/effective
Machine ground brake effective
Basket escape equipment in situation & complete
Basket escape equipment undamaged
Certification
Others
Remarks:
Any piece of equipment not coming up to the required standards of the Project will not be
allowed on / removed / off the project until the necessary repairs have been carried out to the
equipment.
Initial Inspection Monthly Inspection
Name of CEIL Inspector: Name of the Inspector:
Signature: Signature:
Date: Date: