Leidal & Hart Safety App

Project Name

Qualified User/Operator (Full Name)

Location

Motorized Unit Serial Number

Contractor

Date

Equipment Make/Model

Access and Safety

A legible copy of the Owner's manual is present in the toolbox.

Yes

No

Access stairs, ramps and door are clear of any obstruction and in good condition.

Yes

No

All access panels are clear of material and equipment.

Yes

No

All safety guardrails are in position and gates are operational and lock properly (no fall hazard).

Yes

No

An evacuation plan specific to the job site is available to all workers.

Yes

No

If motorized unit is used with accessories, the daily inspection of each accessory present on the setup has been performed.

Yes

No

If the work platform is accessed from inside the building or off a scaffold stair tower, transfer is safe and free from obstruction.

Yes

No

Minimum clearance from overhead power lines is maintained according to local regulation.

Yes

No

On special façade shapes, cross box kits, face guardrails and plank guardrails are properly installed and secure.

Yes

No

Operator is qualified and has a valid training certification.

Yes

No

Perimeter of setup is safe and delimited (warning tape, concrete blocks). Proper barriers have been installed and are in place.

Yes

No

Setup and installation meet the requirements prescribed by owner’s manual or approved engineering drawing.

Yes

No

The platform clears all obstacles (building, balconies, etc.) and can be raised or lowered.

Yes

No

Weather and wind speeds forecasts have been validated and are within the parameters specified by the Owner's manual for the configuration used. Monitoring of weather and wind speeds must be performed throughout the work shift to ensure they remain within the specified parameters.

Yes

No

Work and circulation areas on the platform are clear of any obstruction and kept clean with good housekeeping.

Yes

No

Base

Base is level and cribbing under jacks has not moved.

Yes

No

Bearing surface has been inspected. Bearing surface is stable and has not been subject to any type of erosion or deterioration caused by weather conditions (snow, rain, etc.).

Yes

No

Motorized Unit - Components

Control joystick has been verified and is functioning properly.

Yes

No

Each cylinder hook, secondary hook and lowering cam is in good condition, funtions properly and engages correctly on the mast rung.

Yes

No

Each cylinder, hydraulic hose and hydraulic component is free of leaks and signs of wear.

Yes

No

Each roller has been greased using Prolab GS1000 #28840 only. (WEEKLY)

Yes

No

Each roller has been verified and is in good condition.

Yes

No

Emergency stop has been verified and is working properly. IGNITION MUST BE TURNED OFF when the unit is not in operation.

Yes

No

Gasoline and engine oil levels are appropriate or have been replenished.

Yes

No

Hydraulic oil level has been verified and hydraulic tank has been replenished, if required, with oil recommended by Hydro Mobile.

Yes

No

Lifting mechanism is clear of debris (mortar, masonry material, etc.) and shows no signs of excessive wear.

Yes

No

Motorized unit structure has been inspected and shows no signs of damage or distortion.

Yes

No

Rubber on each cylinder hook has been verified as described in Owner’s manual procedure and is in good condition.

Yes

No

Motorized Unit - Safety Devices

A fire extinguisher is present and readily available. The fire extinguisher is appropriate for the application, in good condition, fully charged and with a valid inspection tag.

Yes

No

Each backup safety hook has been inspected and shows no sign of engagement prior to inspection. Each safety hook is clean and can move freely. The motorized unit must be put out of service and must be inspected by a qualified technician if a previous engagement of the backup safety hook is detected or suspected.

Yes

No

With the setup at 10' (3 m) above the bearing surface and without any loads on the platform, testing of the emergency descent system has been performed (on installation and subsequently once a week) to make sure it is operating normally. (WEEKLY)

Yes

No

Mast and Mast Ties

Mast bolts are tightened with the proper torque (120 lb-ft or 163 N-m). Mast bolt washers have been replaced if bent. (WEEKLY)

Yes

No

Mast is plumb (both front and side axis).

Yes

No

Mast sections have been inspected and show no signs of damage or distortion.

Yes

No

Mast ties are in good condition, show no signs of distortion, are secure and show no signs of collision with planks or mast tie doors.

Yes

No

Tie configuration is as per manufacturer's requirements and suitable for configuration and installation method used.

Yes

No

Visual inspection shows all mast bolt assemblies are in position and tightened properly.

Yes

No

Option 3

Bridges and Planking

All required bridge connection hardware (bolts, nuts, pins, plates) is present and in good condition.

Yes

No

Bridges have been inspected and their structure shows no signs of damage or distortion.

Yes

No

On a bearing bridge, the inclinometers have been verified and detect ±2-degree slopes at both ends of the structure

Yes

No

Outrigger and planking arrangement meets the requirements and limitations outlined in the Owner's manual for the specific configuration used on the setup.

Yes

No

Plank outriggers are clean and in good condition. Outrigger lock bolts are all tightened properly and plank stop pins are in place.

Yes

No

Planks used for planking are scaffold graded (SPF), are clean, in good condition and are set properly. Planking clears all obstacles (building, balconies, etc.) and is properly supported, overlapped and secured.

Yes

No

Loads

If applicable, valid job-specific configuration details and capacity charts are displayed and legible.

Yes

No

Load capacity charts are displayed and legible.

Yes

No

Loads on the platform do not exceed those prescribed by the capacity charts or by the job-specific authorized layout plan and are evenly distributed.

Yes

No

Hydro Mobile Inspection Checklist

Hydro Mobile Inspection Checklist

(810) 629-1504

Hydro Mobile Inspection Checklist﻿

Hydro Mobile Inspection Checklist

(810) 629-1504

Hydro Mobile Inspection Checklist