Project Information Project Name: Model No: Vehicle: Manufacture Name: Company Name: Serial No: Plate No: Date: INSPECTION, TEST & VERIFICATION RECORD Sr. Verification Yes No N/A Comments 1. Lifting Plan 2. Risk Assessment 3. Training Document 4. Lifting tackle 5. Operator 6. Vehicle Regulation Document 7. 3rd Party Inspection Records 8. Internal Inspection Records Attach operator pre-use safety check 9. Repair & Maintenance Records 10. Tire Pressures Vehicle specific checks dependent upon type Tilt/ inclinometer Indicator • Other Specific………………………………………………………………………………… • Load Indicator With load • Other Specific………………………………………………………………………………… • Fork T Lock • Other Specific………………………………………………………………………………… • Audio Load or Tilt alarm • Other Specific………………………………………………………………………………… • PERMIT TO RETURN TO WORK This Vehicle has been Inspected, tested and document verified in accordance with the above and any other aspects specific to the type Authorized Party Name Signature Date Plant Department: HSE Department: