| Project Address | |||
| General Contractor | DOB Job No. | ||
| Equipment ID / Tag No. | Equipment Type | Boom (Articulating) Telescoping Scissor | |
| Make & Model | Serial No. | ||
| Operator Name | Operator Certification No. | ||
| Date | Time of Inspection | ||
| Structural Inspection — ANSI A92.5 §5.2 | PASS | FAIL | N/A | |
| 1 | Work platform, handrails, toe boards, and entry gate intact — no cracks, deformation, or broken components | |||
| 2 | All boom sections, jibs, and telescoping extensions structurally sound — no deformation, cracking, or damaged welds | |||
| 3 | All pivot pins, locking pins, and connection fasteners properly installed and retained — no fasteners absent | |||
| 4 | Outriggers / stabilizer pads deployed to full extension and resting on stable, level ground | |||
| 5 | Tire pressure within manufacturer's specified range — tires free of cuts, sidewall bulges, or embedded debris | |||
| 6 | Drive axle, wheels, and hub assemblies free of damage or excessive wear | |||
| Control Systems — OSHA 1926.453(b) | PASS | FAIL | N/A | |
| 7 | Ground-level controls verified operational — all functions respond correctly and controls are legibly labeled | |||
| 8 | Platform controls tested — all movement functions respond smoothly and are properly labeled | |||
| 9 | Emergency descent function tested from ground level and confirmed operable | |||
| 10 | Platform level indicator accurate and within manufacturer's permissible limits | |||
| 11 | Dead-man / foot-switch control tested — machine halts upon release of the control | |||
| 12 | Horn / audible warning device functional | |||
| 13 | Motion / travel alarm operational | |||
| Safety Devices & Fall Protection — OSHA 1926.453 / ANSI A92.5 | PASS | FAIL | N/A | |
| 14 | Platform rated capacity placard posted and legible — rated capacity not exceeded | |||
| 15 | Guardrails at required height (42" ± 3") with mid-rail and toe board on all open sides | |||
| 16 | PFAS anchor point rated ≥5,000 lbs.; all workers wearing full-body harness above 6 ft. | |||
| 17 | No makeshift platforms, planks, or ladder extensions used from the work platform | |||
| 18 | Outrigger interlock functional — boom will not extend without outriggers deployed (if equipped) | |||
| Fluid Systems & Engine | PASS | FAIL | N/A | |
| 19 | Engine oil, hydraulic fluid, and coolant at proper operating levels | |||
| 20 | No visible fuel, hydraulic fluid, or coolant leaks | |||
| 21 | Hydraulic hoses and fittings free of abrasion, crimping, or chafing damage | |||
| 22 | Battery charged and terminals clean; connections tight (electric models) | |||
| 23 | Fuel level adequate for planned work duration | |||
| Site & Environmental Conditions | PASS | FAIL | N/A | |
| 24 | Work surface and subsurface conditions assessed — no utilities, voids, or soft/unstable soil beneath outrigger pads | |||
| 25 | Overhead electrical clearance confirmed — minimum safe approach distance per OSHA 1926.1408 | |||
| 26 | Prevailing wind speed verified within manufacturer's maximum operating threshold — suspend operations if limit is exceeded | |||
| Operator Name (print) | Certification No. | ||
| Operator Signature | Date & Time |
| Supervisor / SSM (print) | License / Title | ||
| Signature | Date |