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Locations
Tampa
Atlanta
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Mulberry
Ocala
Orlando
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Sarasota
Space Coast
Tallahassee
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Jobsite Safety/Compliance Audit
Jobsite Safety/Compliance Audit
Date
MM slash DD slash YYYY
Branch
Ft. Myers
Jacksonville
Miami
Mulberry
Ocala
Orlando
Panama City
Space Coast
Tallahassee
Tampa
Vero Beach
West Palm Beach
Unit Number
*
Rental Equipment Type
Crane
Aerial Work Platform
Forklift
Personnel/Material Hoist
Equipment Model Number
Manufacturer
Tadano
Linkbelt
Kobelco
Grove
Manitowoc
American
Potain
Terex
Leibherr
Champion
JLG
Skytrak
Lull
VersaLift
Mantis
Other
Customer Name
Email
Job Site Name
Job Site Address Line 1
Job Site Address Line 2
Job Site City
Job Site State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Job Site ZIP
Job Site Description
Audit Item Documentation
Annual Inspection Sticker Legible
Yes
No
Annual Inspection Certificate Current or Present
Yes
No
Annual Inspection Cert. Date
MM slash DD slash YYYY
Unit Daily Inspection Log Completed
Yes
No
Operator Manual Present
Yes
No
Load Charts Present
Yes
No
Power Lines-Hand Signals-etc. Safety Decals Visible
Yes
No
Job Ticket Signed - Top Signature
Yes
No
Audit Item Safety
Sims Crane Employees Wearing PPE
Yes
No
Other Trades Wearing PPE
Yes
No
Swing Radius Barricaded with Caution Tape
Yes
No
Upper and Lower Fire Extinguisher Present
Yes
No
Fire Extinguisher Charged
Yes
No
Cabs Safety Glass-Windows Intact
Yes
No
CCO or FLT Operator Certified Current
Yes
No
Audit Item DOT-Road Cranes or Support Trucks
Pre and Post Trip Driver Vehicle Insp. Report Complete
Yes
No
Reflectors and Lights Working Properly
Yes
No
Mud Flaps Attached
Yes - Good Condition
No - Poor Condition
Permit Current and Present
Yes
No
Insurance Card Current and Present
Yes
No
Tires Condition
New - Good
Questionable
Poor - Needs Replacement
DOT Annual Inspection Current and Present
Yes
No
DOT Annual Inspection Date
MM slash DD slash YYYY
DOT Annual Inspection Sticker Legible
Yes
No
Audit Item Machine Setup and Condition
Wire Rope
Good - New
Questionable
Bad - Needs Replacement
Fluid Leaks
Yes
No
Hook Safety Latch and Gate Safety Latch
Yes - Good
No - Poor
Outriggers Taped Off
Yes
No
Crawlers-Outriggers-Pads-Tires Setup and Condition
Good Condition and Proper Setup
Questionable
Poor Condition or Improper Setup
LMI-ATB-etc. Operator Safety Aids
Yes - Present and Functioning
No - Not Functioning
LMI or ATB NOT Equipped
Mats-Cribbing-Dunnage
Yes - Present and Good Condition
Not Present
Not Adequate or Poor Condition
Machine Level
Yes
No
Audit Item Load Concerns
Is Personnel Lifting Basket in use
Yes
No
Is Personnel Lifting Form in use
Yes
No
Rigging
by Sims
by Customer
by 3rd Party or Others
Signal Method
Verbal Signals
Hand Signals
Mental Telepathy
No Signals Used
Rigging Type
Signal Person Name
Taglines Used
Yes - Adequate
No - Inadequate
Audit Item Hazards
Weather Conditions - check all that apply
Clear
Cloudy
Cold
Dry
Emergency Conditions
Foggy
Hot
Rainy
Wet
Windy
Power Lines in Work Area
Yes
No
Location and Distance of Nearest Power Lines
Underground Hazards in Work Area
Yes
No
Underground Hazards Details
Obstacles in Load Path
Yes
No
Obstacles in the Blind
Yes
No
Operator Aware of Hazards
Yes
No
Additional Audit Details
Auditor Name
Operator Name
Customer Safety Contact
Oiler Name
Observations or Comments
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