NATIONAL CRANE

PERSONNEL LIFTING PLATFORM

DIVISION

EQUIPMENT #

MANUFACTURER

MODEL #

SERIAL #

PURPOSE OF INSPECTION: PRE-USE MONTHLY ACCIDENT

JURISDICTION: OSHA 1926.550 ANSI B30.5 5-3.2.2(b)

ITEM * SAT UNSAT

1. VISUALLY INSPECT SYSTEM FOR GENERAL CONDITION
2. LOCK MECHANISM FOR PROPER OPERATION AND WEAR
3. INTERLOCK SYSTEM FOR PROPER OPERATION
4. LUBE OR OIL (cylinder pins, main pivot trunnion, rotation brgs, chain and
sprockets)
5. HYDRAULIC SYSTEM, HOSE DAMAGE AND LEAKS
6. POWER CORD (cuts, frayed, etc.)
7. DECALS FOR LEGIBILITY
8. LOOSE BOLTS AND CHAIN TENSION

IF AN ITEM IS FAULTY, USE REMARK SECTION

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* ITEMS 3, 5 & 6 DO NOT APPLY TO NON-SELF LEVELING PLATFORMS

PERSONNEL LIFTING YES NO TAGGED YES NO DATE/TIME

PLATFORM READY FOR OUT
SERVICE

OPERATOR / INSPECTOR______________________________________ DATE _________________

ALL FAULTY ITEMS REPAIRED ________________________________ DATE _________________

This list is not intended to replace the manual. Any deficiencies shall be carefully examined and a
determination made as to whether or not they constitute a hazard.