HSE MANAGEMENT

SYSTEM
HYDRAULIC JACK INSPECTION CHECKLIST

AREA: YEAR:

NOTE

Do not "tick", write OK, or use the number of the specific deviation given in the legend. If the equipment is defective
it must be tagged - "Defective" and must be reported to the person responsible for the repair of the equipment. If the
equipment is beyond repair it must be destroyed and discarded. New equipment to replace the discarded equipment
must be obtained to discourage the use of make shift equipment

LEGEND
(Indicate the action to be taken in the ACTION column by number code as indicated below.

Specify the exact repairs to be done on the works request or job-card.)

CHECKLIST CORRECTIVE ACTION

1 Jack not numbered/number illegible 1 None - In good state of repair

2 Maximum mass load not indicated on jack 2 Clean the jack of all oil and grime
3 Dirty - oil/dust etc. on Jack 3 Number the jack in a legible manner
4 Hydraulic oil leaks 4 Replace the hydraulic oil seals
5 Pressure release valve damaged/inoperative 5 Replace/Repair pressure release valve
6 Piston damaged 6 Repair/replace the piston of the jack
7 Oil seals leak or is damaged 7 Send jack for repairs to competent repair company
8 Jack cannot hold/lift rated mass load 8 Beyond repair - Discard
9 Other specify:
During inspection the rated maximum mass load (MML) must
be lifted with the jack and it should stay in the elevated
position. If the piston slowly slide back under the weight - the
jack must be sent away to the supplier or a competent
hydraulic engineer or workshop to repair the jack and issue a
certificate that it is safe to use and will hold the rated MML of
the jack

1ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER

ID NO DEPARTMENT
CHECK ACTION CHECK ACTION CHECK ACTION CHECK ACTION

DATE INSPECTED

INSPECTOR’S INITIALS

AUDIT/SPOT CHECK

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