Shapoorji Pallonji & Co.Pvt.

Ltd
GIPL
Checklist for Boom Lift
8

2
4

DAY Mon Tu We Th Fr Sa Su

Sr No Check items Y/N Y/N Y/N Y/N Y/N Y/N Y/N

1 SWL marked on bucket

2 Bucket Safety door in good condition

3 No damage in tyres (cracks,cut , air pressure etc.)

4 Emergency switch is in working condition

5 Emergency rescue system is in working condition (when engine fails)

6 No Oil Leaks (Hydraulic parts , engine & fuel tank)

7 Boom Structure condition while full expansion (damage ,crack & jamming while extension

8 Machine Marching Alam in working condition

9 Fire Extinguisher availability

10 Appropriate PPEs available with operator & Signal Person

11 Documents for scissor lift - Model : _________________________________

Chasis No : __________________________________ SWL : ______________

a Valid Third part certificate. Due date of TPI : _____________________

b Vehicle valid insurance . Insurance valid Till : ____________________

c Operator certificate . Operator Name : Mr. ____________________________ID No: ________

Remark :-

Inspected By Verified By
 CHECKLIST FOR BOOM LIFT

IDENTIFICATION
SITE ID NO. :- DATE OF INSPECTION :
SERIAL NO. :- DUE DATE :
SUB CONTRACTOR :-

PARAMETERS DATE

Check Points OK / Not Ok / OK / Not Ok /

OK / Not Ok / N/A OK / Not Ok / N/A OK / Not Ok / N/A OK / Not Ok / N/A OK / Not Ok / N/A Remark
N/A N/A

SWL marked on bucket

Bucket Safety door in good condition
No damage in tyres (cracks,cut , air pressure etc.)
Emergency switch is in working condition
Boom Structure condition while full expansion (damage ,crack & jamming
while extension

Emergency rescue system is in working condition (when engine fails)

No Oil Leaks (Hydraulic parts , engine & fuel tank)

Machine Marching Alam in working condition
Fire Extinguisher availability

Appropriate PPEs available with operator & Signal Person

Valid Third part certificate.

Operator details ( Photograph,Mobile no,details of machine displayed)

Vehicle valid insurance

C) INSPECTION BY

Accepted Within Condition Accepted Reject Remark

Name & sign of PNM Person

Name & sign of HSE Person

Name & sign EHS Client Person

(Only sign for first time entry of TEV/ETM)