Cherry Picker/Boom Lift HSE Inspection Checklist

Project & Department Name : ……………………………………………………………………..

Work Location : ……………………………………………………………………..
Cherry Picker/Boom Lift type, : ……………………………………………………………………..
model & Capacity
Operator Name : ……………………………………………………………………..
Driving License No., Type & : ……………………………………………………………………..
Expiry date
Calibration Certificate Expiry Date : ……………………………………………………………………..
Date of Inspection : ……………………………………………………………………..

S SAT USAT NA Remarks

Item Description
N
1 No Damage in Tire ( Crack, cut, air pressure etc).
.Platform is securely fastened to platform support
2
Ensure not more than 3 members loaded at a time in the
3 .platform

All member in the platform have safety belt

4
.Foot pedal in the bucket is in working condition
5
Outriggers & extendable axles are in smooth working
6 .condition

.High engine and height drive cutout is in working condition

7
.Any oil leakage in the Hydraulic systems
8
.LOTO system is available in the ground panel board
9
.Warning lamp is in working condition
10
The cherry picker movement/ work area is
11 leveled ,compacted and free from all obstructions

Operator details(Photograph,Licence, Mobile no,Cherry

12 .picker details etc) displayed in the cabin

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Other remarks and additional comments or suggestions:

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The above inspected Cherry Picker/Boom Lift is accepted for safe Yes No
use

Inspected By:
Name: ……………....................... Position: ……………..................... Signature: ……………...
Name: ……………....................... Position: ……………..................... Signature: ……………...
Note: The inspector(s) is /are responsible to bring unsatisfactory items to the attention of his/her
supervisor and /or the concerned department.
SAT Satisfactory USAT Unsatisfactory NA Not Applicable

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