JACKHAMMER INSPECTION CHECKLIST
AREA/SECTION: YEAR:
JACKHAMMER NO.: MONTH:
NOTE: Do Not “tick”. Write “OK” or “DEF”. If the equipment is defective it must be reported to the person responsible for the repair or replacement of the equipment. If
the equipment is defective it must be tagged as “DO NOT USE” a tag must be clearly displayed on the equipment. If the equipment is beyond repair it must be destroyed
and discarded and replaced with new equipment.
DEVIATION CHECKLIST CORRECTIVE ACTION
1. Overall Condition 1. Report to Supervisor
2. Casing of Jackhammer 2. Take immediate action
3. Moil holder 3. Take immediate action
4. Moil 4. Replace
5. Switches in good order 5. Report to Supervisor
6. Handles 6. Report to Supervisor
7. Trigger 7. Take immediate action
8. Hydraulic oil 8. Take immediate action
9. Hose 9. Replace
10. Couplings 10. Replace
11. Safety whips 11. Attach
12. On Register 12. Place on Register
13. Tagged 13. Tag
14. 14.
15. 15.
16. 16.
FROM: TO:
No. JACKHAMMER ____________________ __________________
MON TUE WED THU FRI SAT SUN
1 Overall Condition
2 Casing of Jackhammer
3 Moil holder
4 Moil
5 Switches in good order
6 Handles
7 Trigger
8 Hydraulic oil
9 Hose
10 Couplings
11 Safety whips
12 On Register
13 Tagged
14
15
16
17
18
SAFE TO USE:
DATE OF INSPECTION:
SIGNATURE OF INSPECTOR:
SIGNATURE OF SUPERVISOR:
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Jackhammer Inspection Checklist