<Project Name>

< CLIENT LOGO >

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Cherry Picker/Boom Lift 3

Name of Contractor: Date:

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Operator Name: Doc. No :
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Sr No Description YES NO NA Remarks

1 No Damage in Tire ( Crack, cut, air pressure etc).

2 Platform is securely fastened to platform support.

Ensure not more than 3 members loaded at a time in the

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platform.

4 All member in the platform have safety belt

5 Foot pedal in the bucket is in working condition.

6 Outriggers & extendable axles are in smooth working condition.

7 High engine and height drive cutout is in working condition.

8 Any oil leakage in the Hydraulic systems.

9 LOTO system is available in the ground panel board.

10 Warning lamp is in working condition.

The cherry picker movement/ work area is leveled ,compacted

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and free from all obstructions
Operator details(Photograph,Licence, Mobile no,Cherry picker
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details etc) displayed in the cabin.

Remarks
 Contractor's Company Client's
Representative Representative Representative

Signature:

Name:

Date:
#REF!