Man/Aerial-Lift Pre-Use Safety Inspection Procedure

All hazardous energy has been isolated using LOTO procedures?

All potential stored or residual energy has been relieved, disconnected, restrained, lowered, and/or otherwise rendered safe?

Lock Out Tag Out

LOTO Performed

Food Safety Pre-Check

Prior to performing this maintenance task, the areas that may be impacted unintentionally by the maintenance activities were inspected to assure no Partner’s safety is at risk and no customer product or Cintas equipment would be compromised, contaminated, or otherwise damaged due to this specific task. Any product that may be impacted was moved and / or otherwise isolated to assure protection.

LEAKS TO HYDRAULIC POWER UNIT, TANK, HOSES, FITTINGS, CYLINDERS AND MANIFOLDS (ADD OIL IF NEEDED)

Pass
Flag
Fail

BE SURE THAT ALL STRUCTURAL AND OTHER CRITICAL COMPONENTS ARE PRESENT AND ALL ASSOCIATED FASTENERS AND PINS ARE IN PLACE AND PROPERLY TIGHTENED

Pass
Flag
Fail

BE SURE THAT THE OPERATOR'S SAFETY AND RESPONSIBILITIES MANUALS ARE COMPLETE, LEGIBLE AND IN THE STORAGE CONTAINER LOCATED ON THE PLATFORM

Pass
Flag
Fail

CHECK FOR BATTERY FLUID LEAKS AND PROPER FLUID LEVEL. ADD DISTILLED WATER IF NEEDED

Pass
Flag
Fail

The Aerial/Man-Lift will be taken out of service if any mechanical or structural item on the checklist is found to be unacceptable. Once corrected, the Man-Lift can be operated.

Pass
Flag
Fail

Food Safety Post-Check

After performing this maintenance task, a review of all applicable areas that may have been impacted was conducted to assure there are no residual risks to Partner safety remaining. Also, a review of all applicable areas to ensure that no customer products were inadvertently compromised, contaminated, or otherwise damaged was conducted. If any conditions were observed indicating that any of the previous concerns have been negatively impacted, the issue was escalated to leadership.

Man/Aerial-Lift Pre-Use Safety Inspection Procedure

Man/Aerial-Lift Pre-Use Safety Inspection Procedure

* LOTO Confirmation Statement - DO NOT EDIT/REMOVE *

All hazardous energy has been isolated using LOTO procedures?

Yes

N/A

All potential stored or residual energy has been relieved, disconnected, restrained, lowered, and/or otherwise rendered safe?

Yes

N/A

Lock Out Tag Out

LOTO Performed

Yes

No

Food Safety Pre-Check

Check All Safety Inspection Items Listed Below

ELECTRICAL COMPONENTS, WIRING AND ELECTRICAL CABLES

LEAKS TO HYDRAULIC POWER UNIT, TANK, HOSES, FITTINGS, CYLINDERS AND MANIFOLDS (ADD OIL IF NEEDED)

BATTERY PACK AND CONNECTIONS

OUTRIGGERS, WEAR PADS

TIRES AND WHEELS (CRACKS, CHUNKS MISSING)

LIMIT SWITCHES

NUTS, BOLTS, AND OTHER FASTENERS

PLATFORM ENTRY CHAIN OR GATE

BEACON AND ALARMS (HORN, BACKUP ALARM, LIGHTS, IF EQUIPPED)

SECUENCING CABLES AND PULLEY

MAST COLUMNS AND COUNTERWEIGHT

PLATFORM CONTROL BUTTONS

CRACKS IN WELDS OR STRUCTURAL COMPONENTS

DENTS OR DAMAGE TO MACHINE

BE SURE THAT ALL STRUCTURAL AND OTHER CRITICAL COMPONENTS ARE PRESENT AND ALL ASSOCIATED FASTENERS AND PINS ARE IN PLACE AND PROPERLY TIGHTENED

BE SURE THAT THE OPERATOR'S SAFETY AND RESPONSIBILITIES MANUALS ARE COMPLETE, LEGIBLE AND IN THE STORAGE CONTAINER LOCATED ON THE PLATFORM

BE SURE THAT ALL DECALS ARE LEGIBLE AND IN PLACE

CHECK FOR BATTERY FLUID LEAKS AND PROPER FLUID LEVEL. ADD DISTILLED WATER IF NEEDED

The Aerial/Man-Lift will be taken out of service if any mechanical or structural item on the checklist is found to be unacceptable. Once corrected, the Man-Lift can be operated.

Comments

Check this box if using a rental

Inspector's Signature

Food Safety Post-Check

*** LOTO Confirmation Statement - DO NOT EDIT/REMOVE ***

All hazardous energy has been isolated using LOTO procedures?

Yes

N/A

All potential stored or residual energy has been relieved, disconnected, restrained, lowered, and/or otherwise rendered safe?

Yes

N/A

Lock Out Tag Out

LOTO Performed

Yes

No

Food Safety Pre-Check

Check All Safety Inspection Items Listed Below

ELECTRICAL COMPONENTS, WIRING AND ELECTRICAL CABLES

LEAKS TO HYDRAULIC POWER UNIT, TANK, HOSES, FITTINGS, CYLINDERS AND MANIFOLDS (ADD OIL IF NEEDED)

BATTERY PACK AND CONNECTIONS

OUTRIGGERS, WEAR PADS

TIRES AND WHEELS (CRACKS, CHUNKS MISSING)

LIMIT SWITCHES

NUTS, BOLTS, AND OTHER FASTENERS

PLATFORM ENTRY CHAIN OR GATE

BEACON AND ALARMS (HORN, BACKUP ALARM, LIGHTS, IF EQUIPPED)

SECUENCING CABLES AND PULLEY

MAST COLUMNS AND COUNTERWEIGHT

PLATFORM CONTROL BUTTONS

CRACKS IN WELDS OR STRUCTURAL COMPONENTS

DENTS OR DAMAGE TO MACHINE

BE SURE THAT ALL STRUCTURAL AND OTHER CRITICAL COMPONENTS ARE PRESENT AND ALL ASSOCIATED FASTENERS AND PINS ARE IN PLACE AND PROPERLY TIGHTENED

BE SURE THAT THE OPERATOR'S SAFETY AND RESPONSIBILITIES MANUALS ARE COMPLETE, LEGIBLE AND IN THE STORAGE CONTAINER LOCATED ON THE PLATFORM

BE SURE THAT ALL DECALS ARE LEGIBLE AND IN PLACE

CHECK FOR BATTERY FLUID LEAKS AND PROPER FLUID LEVEL. ADD DISTILLED WATER IF NEEDED

The Aerial/Man-Lift will be taken out of service if any mechanical or structural item on the checklist is found to be unacceptable. Once corrected, the Man-Lift can be operated.

Comments

Check this box if using a rental

Inspector's Signature

Food Safety Post-Check

* LOTO Confirmation Statement - DO NOT EDIT/REMOVE *