develop me a duct jack annual inspection form in accordance with the 1926 construction standards

Duct Jack Annual Inspection Checklist =====================================

Date: 2026-01-27

Inspector: \[INSPECTOR NAME]

Location/Area: \[LOCATION/AREA]

Department: \[DEPARTMENT]

Purpose

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To ensure duct jacks are in safe operating condition and comply with OSHA 29 CFR 1926 standards. This inspection should be conducted annually by a qualified person.

Instructions for Use

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1. 1\. Visually inspect the duct jack for any signs of damage or wear.
2. 2\. Perform functional testing to ensure the jack operates correctly and safely.
3. 3\. Check the hydraulic system (if applicable) for leaks and proper operation.
4. 4\. Check the screw mechanism (if applicable) for damage and proper operation.
5. 5\. Record the inspection findings and any corrective actions taken.
6. 6\. Ensure that the inspection is performed by a qualified person.
7. 7\. Maintain inspection records for a minimum of 12 months. \[1926\.1412(f)(7\)]

Frequency

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This checklist should be completed: Annually

Safety Checklist

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General Requirements

These requirements apply to all duct jacks regardless of type or application.

Visual Inspection

Inspect the jack for any signs of physical damage or wear.

Functional Testing

Test the jack to ensure it operates correctly and safely.

Hydraulic System (if applicable)

Inspect the hydraulic system for leaks and proper operation.

Screw Mechanism (if applicable)

Inspect the screw mechanism for damage and proper operation.

General Requirements

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Failed Item Procedures

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1. If any deficiency is identified, an immediate determination must be made by the qualified person as to whether the deficiency constitutes a safety hazard or, though not yet a safety hazard, needs to be monitored in the monthly inspections. \[1926\.1412(f)(4\)]
2. If the qualified person determines that a deficiency is a safety hazard, the equipment must be taken out of service until it has been corrected. \[1926\.1412(f)(5\)]
3. If the qualified person determines that, though not presently a safety hazard, the deficiency needs to be monitored, the employer must ensure that the deficiency is checked in the monthly inspections. \[1926\.1412(f)(6\)]

Documentation Requirements

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The following information must be documented and maintained for a minimum of 12 months: \[1926\.1412(f)(7\)]

• The items checked and the results of the inspection. \[1926\.1412(f)(7\)(i)]
• The name and signature of the person who conducted the inspection and the date. \[1926\.1412(f)(7\)(ii)]

Checklist Completion

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Overall Status: ☐ Pass     ☐ Fail     ☐ Corrective Actions Required

Inspector Signature: Date:

Supervisor Review: Date:

Corrective Actions Completed By: Date:

References and Standards

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• OSHA 29 CFR 1926 Subpart I - Tools - Hand and Power \[1926\.305]
• OSHA 29 CFR 1926\.1412 - Inspections
• OSHA 29 CFR 1926\.1413 - Wire rope--inspection

This checklist must be retained for \[RETENTION PERIOD].

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