Dock Leveler Inspection Checklist Form
Use this form to record a dock leveler inspection, note condition, and document any required follow-up.
Inspection Details
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Inspector Name
*
Facility / Location
*
Dock Leveler ID / Equipment Identifier
*
Dock Leveler Condition Checklist
Dock leveler condition checklist
*
Rows
Pass
Fail
Needs Attention
Platform surface
1
2
3
Lip extension
4
5
6
Hinges and pins
7
8
9
Hydraulic or mechanical operation
10
11
12
Controls
13
14
15
Safety devices
16
17
18
Visible damage or wear
19
20
21
Overall condition/status
*
Pass
Needs Attention
Fail
Comments / defects notes
*
Inspection Outcome and Follow-up
Action Needed
*
No action needed
Monitor
Repair required
Remove from service
Next Inspection / Follow-up Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Signature
*
Submit Inspection
Submit Inspection
Should be Empty: