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MOBILE ELEVATED WORK PLATFORMS
(To be completed on Weekly basis)
Page 1 of 1 Form # HSEQ- MEWPs (Rev 1 – Mar 23)
Project Information
Project Name: Company Name:
Location: Date :
Equipment type: Plate No:
MEWP CHECKS BY HSE
Status
OK
NOT
OK
N/A
1 Pre-operational checklist
2 Risk Assessment/Method Statement
3
MEWPs should be operated on level
ground
4
Ensure maintenance records are kept
up to date and documented
5
Area Barricaded and Warning signs
placed
6 Housekeeping
7 Bumps and floor/ground obstructions
8
Minimum of three trained, experienced,
competent and certified operatives
(two at the platform and one at the
ground)
9 Full body harness
10 Overhead obstructions
11 Energized power lines
12 Control markings
13 Hazardous locations
14 Ground surface and support conditions
15 Pedestrian/vehicle traffic
16 Wind and weather conditions
17
Operator License & Third Party
certificate
18
3rd Party Plant or Equipment
Certificates
19
First Aid Box & Fire Extinguisher
Available
20 Accessory plugs and cables
MEWP CHECKS BY PLANT
Status
OK
NOT
OK
N/A
1
Wheels and Tires in good
condition
2 Drive – forward/reverse
3 Steer – left/right
4 Platform – tilt/rotate/extend
5 Stability enhancing devices
6
Function-enable (Deadman)
devices
7 Emergency/auxiliary controls
8 Braking – stops & holds
9 Lights functioning
10 Control panels in good condition
11
Boom/lift arms – general
condition/wear
12
Platform – guardrails/toe
board/anchorages/gate
13 Unit starts and runs properly
14 Warning lights/audible alarms
15 Instruments/Gauges
16 Fuel/Charge level
17 Horn/audible warning device(s)
18
Boom/Jib/Lift Arms –
raise/lower/extend/retract
19
Pressure Sensing Bar Installed
and functioning
20
SWL displayed in a prominent
location
21
Up-Stand above the platform
control panel installed
22
Others (Specify):
Remarks:
Inspected By Plant: Signature:
Inspected By HSE: Signature:
Reviewed By HSE Manager / In charge: Signature:
☐ Passed ☐ Remove for Maintenance ☐ Rejected (Remove from project)

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