FORK LIFT - EQUIPMENT CHECKLIST # 009

EQUIPMENT TAG / REG # -________________

Plant / Location: _____________________________________________ Date:______________________ Time: ___________Model / Year:_____________

Contractor Name: ________________________________ Driver Name: __________________________________

OPERATOR 3rd PARTY CERTIFICATION : ________________ VALIDITY:__________________ (Critical)

EQUIPMENT 3rd PARTY CERTIFICATION: _________________ VALIDITY : _________________ (Critical)

STATIC CRITICAL RELEVANCE

ACCEPTABLE
REMARKS
YES / NO
LIGHTS  FOR USE IN DARK HOURS

FORK 
LIMIT SWITCHES 
SCALE (WEIGHT) 
TYRE CONDITION 
INDICATORS WITH REVERSING ALARM (AUTOMATIC) 
TIE RODS 
SPARK ARRESTOR *  REQUIRED FOR
HYDROCARBON AREA
TYPE / VALIDITY OF LICENSE 
SEAT BELTS 
CHAIN 
FIRE EXTINGUISHER  REQUIRED FOR
HYDROCARBON AREA
OPERATOR CERTIFICATION 
EQUIPMENT CERTIFICATION 

RUNNING CRITICAL RELEVANCE

ACCEPTABLE
REMARKS
YES / NO
ABNORMAL SOUND 
VIBRATION 
EXHAUST PIPE CONDITION 
BRAKES 
OIL & WATER LEAKS 

LEGEND
* REQUIRED FOR HYDROCARBON AREA

OBSERVATIONS AND REMARKS:

Prepare By: Contractor Supervisor Verified by : Approved By : Approved for 15 days only
Contractor Safety supervisor
CSI Approval Date:_________________

Name:_____________________ Name: _______________________

Name: _____________________________
VALID UP TO:_______________________

(Except any break down or fault in the equipment)

Signature: Signature:____________________
Signature: ______________________

(Rev-04A) Apr, 22 Fork Lift EST-301-203-IN-PRO-00006-04