Aerial Lift Induction Form
Complete this form before aerial lift induction or authorization to operate. Provide accurate details about the operator, equipment, site, and supervisor verification.
Inductee Information
Full Name
*
First Name
Last Name
Job Role / Position
*
Employer / Company Name
*
Worksite / Project Location
*
Aerial Lift Induction Details
Aerial Lift Type/Model
*
Scissor lift
Boom lift
Vertical mast lift
Cherry picker
Other
Induction/Training Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Previous Aerial Lift Experience Level
*
None
Limited
Experienced
Certified/Competent
Operator Authorization Status
*
Not yet authorized
Authorized at this site
Requires supervision
Safety and Supervisor Verification
Acknowledgement of safety topics covered
*
Fall protection
Pre-start inspection
Ground conditions
Exclusion zones
Emergency lowering
Power line awareness
Supervisor/Inductor name
*
Supervisor approval to proceed
*
Approved
Not approved
Pending further training
Submit
Should be Empty: