PRE-START CHECKLIST FOR FORK LIFT

Site Name 　 Type of Work 　 Equipment Number 　

Manufacturer 　 Model 　 Capacity 　

Year Manufactured 　 Date of First Use 　 Date of Inspection 　

1 4
Head Light 3 Mast
FOPS 5
Lift Chain
Lift Cylinder

6
Back Rest
1
Beacon
Tail Light
Reverse Alarm
7
Signal Light Tilt Cylinder

8
Fork Locking Pin

9
Tire
2 Wheel Assembly
Steering Cylinder

10
Horn

11
16
Rearview Mirror Shift Lever

12
Rearview Camera

15
Parking Brake

14 13
Inching Pedal Brake Pedal

17 　 Certification 　 19 Oil Leakage 　 　 21 Fire Extinguisher 　 　 23 Alcohol Test 　

18 Permit to Work 　 　 20 Seat Belt 　 22 Banksman/Signal Man 　 　 　
Operator (Sig) Const. Team (Sig) HSE Personnel (Sig)

(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with:  Acceptable;  Unacceptable;  Need Further Check; NA Not Applicable
 Equipment No.
DAILY PRE-START CHECKLIST FOR FORK LIFT
MON TUE WED THU FRI SAT SUN REMARKS
NO. ITEM
/ / / / / / /
Head Light, Beacon, Tail Light,
1
Reverse Alarm, Signal Light
2 Steering Cylinder

3 FOPS
4 Mast, Lift Cylinder
5 Lift Chain
6 Back Rest
7 Tilt Cylinder

8 Fork Locking Pin

9 Tire, Wheel Assembly

10 Horn

11 Shift Lever
12 Rearview Camera

13 Brake Pedal
14 Inching Pedal
15 Parking Brake

16 Rearview Mirror
17 Certification

18 Permit to Work

19 Oil Leakage
20 Seat Belt
21 Fire Extinguisher

22 Banksman/Signal Man
23 Alcohol Test
24

25
26
27
Operator (Name: )

Sig. Const. Team (Name: )

HSE Personnel (Name: )

(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with:  Acceptable;  Unacceptable;  Need Further Check; NA Not Applicable