Elevated Work Platform Safety Checklist
Complete this checklist before operating any elevated work platform to ensure safety compliance.
Operator Full Name
*
First Name
Last Name
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Elevated Work Platform Identification (Model/Serial Number)
*
Pre-Operation Visual Checks (select all that have been inspected and are in safe condition)
*
Guardrails and access gates secure
Wheels/tyres and outriggers inspected
Hydraulic and fuel systems checked for leaks
Emergency lowering system tested
No visible damage or obstructions
Other (please specify)
Are all required Personal Protective Equipment (PPE) available and worn?
*
Yes
No
Not Applicable
Any hazards identified during inspection?
*
No hazards identified
Yes, hazards identified (please describe below)
If hazards were identified, please describe them and actions taken.
Submit Checklist
Should be Empty: