Aerial Lift Test Certificate Form
Use this form to record aerial lift test and inspection results, equipment details, findings, and certification status.
Aerial Lift Identification
Equipment Name or Asset ID
*
Aerial Lift Type
*
Please Select
Boom Lift
Scissor Lift
Truck-Mounted Lift
Other
Manufacturer
*
Model
*
Serial Number
*
Asset Location / Site
*
Test and Inspection Details
Test Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Test Location
*
Inspector/Tester Name
*
First Name
Middle Name
Last Name
Company/Organization
Operating Hours / Usage Reading at Time of Test
Test Result
*
Pass
Fail
Certificate / Record Reference Number
Findings and Certification
Observed Defects or Abnormalities
*
Corrective Actions Taken or Required
Final Certification Status
*
Certified
Certified with Conditions
Not Certified
Certificate Issue Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes / Comments
Submit Certificate
Should be Empty: