Company:

PRE-START CHECKLIST FOR AERIAL MAN-LIFT (ARTICULATED)

Equipment
Site Name Type of Work
Number
Manufacturer Model Capacity
Date of Inspec-
Year Manufactured Date of First Use
tion

1 2 3 4 5 6

Rise Prevention Control Emergency Stop Emergency Foot Fire

Device Panel Button Lowering Button Switch Extinguisher

7
Boom/Structure
8
Alarm Device

9
Hydraulic Cylinder

11 Tire
10
Steering System Wheel Assembly

Overhead/Ground Haz-
12 Certification/Registration 14 16 Fall Protection 18 Alcohol Test
ard on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
(Keep the copy of Daily Pre-Start Equipment Checklist
Note: Mark appropriate boxes
13 Permit to Work with: 15  Acceptable;
Operator’s Certificate  17 Overload
Unacceptable; Need Further Check;
Protection NA Not Applicable

Operator (Sig) Const. Team (Sig) HSE Personnel Form: HDEC-HSE-CE-020

(Sig) (E)
Company:
DAILY PRE-START CHECKLIST FOR AERIAL MAN-LIFT Equipment No.
(ARTICULATED)
MON TUE WED THU FRI SAT SUN REMARKS
NO. ITEM
/ / / / / / /
1 Rise Prevention Device
2 Control Panel

3 Emergency Stop Button

4 Emergency Lowering Button

5 Foot Switch
6 Fire Extinguisher
7 Boom/Structure
8 Alarm Device

9 Hydraulic Cylinder

10 Steering System
11 Tire, Wheel Assembly
12 Certification/Registration
13 Permit to Work

14 Overhead/Ground Hazard
15 Operator's Certificate
16 Fall Protection

17 Overload Protection
18 Alcohol Test

19
20
21
22
23

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

Form: HDEC-HSE-CE-020 (E)