Back Extension Machine Setup Checklist Form
Complete this checklist to ensure the back extension machine is properly set up and safe for use.
Machine Identification Number
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Location of Machine (e.g., Gym Area/Room)
*
Visual Inspection: Are there any visible damages or defects?
*
No visible issues
Minor cosmetic issues only
Requires maintenance
Cleanliness: Is the machine clean and free of debris?
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Yes, clean and ready
No, needs cleaning
Moving Parts: Do all moving parts operate smoothly?
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Yes, operates smoothly
No, needs lubrication/repair
Adjustments: Are seat and pad adjustments functioning and secure?
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All adjustments function and lock securely
Adjustment issues present
Safety Pins/Locks: Are all safety pins and locks in place and secure?
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All secure
Missing or loose components
Signage & Labels: Are all safety instructions and warning labels present and legible?
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Yes, all present and legible
Missing or hard to read
Test Run: Did you perform a test run to confirm proper operation?
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Yes, test run successful
No, issues encountered
Comments or Issues Noted (if any)
Submit Checklist
Should be Empty: