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make a duct jack inspection form

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Duct Jack Safety Inspection Checklist =====================================

Date: 2026-01-27

Inspector: \[INSPECTOR NAME]

Location/Area: \[LOCATION/AREA]

Department: \[DEPARTMENT]

Purpose

To ensure duct jacks are safe to operate and comply with safety regulations. This checklist should be used before each use of a duct jack.

Instructions for Use

  1. Inspect the duct jack before each use, following this checklist.
  2. Ensure the load does not exceed the jack's rated capacity.
  3. Position the jack on a level, stable surface.
  4. Use appropriate cribbing or blocking to support the load.
  5. Never work under a load supported only by a jack.
  6. Lower the load slowly and in a controlled manner.

Frequency

This checklist should be completed: Before each use

Safety Checklist

General Condition

Inspect the overall condition of the duct jack.

ItemPassFailComments
Check for any visible damage to the jack body, such as cracks, dents, or corrosion. Check: Jack body is free from visible damage that could compromise its structural integrity. If failed: Remove the jack from service and send for repair or replace._________________
Inspect the base of the jack for stability and any signs of damage. Check: Base is stable, undamaged, and provides a firm footing. If failed: Do not use the jack if the base is unstable or damaged. Repair or replace the jack._________________
Verify that the jack has a legible and permanently marked load rating. [1] Check: The rated load is legibly and permanently marked in a prominent location on the jack. If failed: If the load rating is missing or illegible, remove the jack from service._________________
Ensure all labels and warnings are present and readable. Check: All safety labels and operating instructions are attached and can be easily read. If failed: Replace any missing or damaged labels before using the jack._________________

Hydraulic System (if applicable)

Inspect the hydraulic components of the duct jack.

ItemPassFailComments
Check for hydraulic fluid leaks around the cylinder, hoses, and fittings. Check: No visible hydraulic fluid leaks are present. If failed: Repair any leaks before using the jack. If leaks cannot be repaired, remove the jack from service._________________
Inspect hydraulic hoses for cuts, kinks, or abrasions. Check: Hoses are in good condition with no signs of damage. If failed: Replace any damaged hoses before using the jack._________________
Verify that the hydraulic pump operates smoothly and maintains pressure. Check: The pump operates smoothly without unusual noises or resistance, and the jack holds its rated load without drifting. If failed: If the pump is not functioning correctly, remove the jack from service and repair._________________
Ensure hydraulic jacks exposed to freezing temperatures are supplied with adequate antifreeze liquid. [1] Check: Hydraulic jacks contain adequate antifreeze liquid. If failed: Add antifreeze liquid as needed._________________

Mechanical Components

Inspect the mechanical parts of the duct jack.

ItemPassFailComments
Inspect the screw mechanism for damage, wear, or corrosion. Check: Screw mechanism is clean, lubricated, and free from damage. If failed: Clean and lubricate the screw mechanism. Replace if damaged or excessively worn._________________
Check the condition of the lifting saddle or attachment point. Check: Lifting saddle is secure and shows no signs of wear or damage. If failed: Replace the lifting saddle if damaged._________________
Verify that the jack has a positive stop to prevent over-travel. [1] Check: Jack has a functional positive stop to prevent over-travel. If failed: Repair or replace the jack if the positive stop is missing or non-functional._________________

Operation and Functionality

Verify the operational performance of the duct jack.

ItemPassFailComments
Test the jack under a light load to ensure smooth and controlled lifting and lowering. Check: Jack lifts and lowers smoothly without jerking or binding. If failed: If the jack does not operate smoothly, remove it from service and repair._________________
Confirm that the jack holds the load securely without slippage. Check: The jack maintains its height under load without any noticeable sinking or slippage. If failed: If the jack slips under load, remove it from service and repair._________________
Ensure the jack is properly lubricated at regular intervals. [1] Check: Jack is properly lubricated at regular intervals. If failed: Lubricate the jack as needed._________________

Work Environment

Assess the surrounding work environment for potential hazards.

ItemPassFailComments
Ensure the work area is free of obstructions and tripping hazards. Check: The area around the jack is clear, providing safe access and operation. If failed: Clear any obstructions or hazards from the work area._________________
Verify that the surface is level and stable. Check: The jack is placed on a level and stable surface capable of supporting the load. If failed: Relocate the jack to a level and stable surface._________________
Confirm sufficient lighting is available. [2] Check: There is sufficient lighting to perform the work safely. If failed: Improve lighting as needed._________________

Personal Protective Equipment (PPE)

Verify the use of required personal protective equipment.

ItemPassFailComments
Ensure that operators wear appropriate PPE, including safety glasses and gloves. [2] [2] Check: Operators are wearing safety glasses and gloves. If failed: Provide and enforce the use of required PPE._________________
Verify that steel-toed shoes/boots are worn. [2] Check: Operators are wearing steel-toed shoes/boots. If failed: Provide and enforce the use of steel-toed shoes/boots._________________

General Requirements

ItemPassFailComments
Ensure all operators are trained on the proper use of duct jacks. Check: Operators have received documented training on safe jacking procedures. If failed: Provide training to all operators before they use the equipment._________________
Inspect jacks that are subjected to abnormal load or shock immediately before and immediately after use. [1] Check: Jacks are inspected before and after use. If failed: Perform the required inspections._________________
Ensure repairs are made on disabled jacks before they are used again. [1] Check: Repairs are made on disabled jacks before they are used again. If failed: Do not use disabled jacks until they are repaired._________________

Failed Item Procedures

  1. Any jack that fails inspection must be immediately removed from service.
  2. Tag the failed jack with a 'Do Not Use' tag.
  3. Repair or replace the jack before returning it to service.
  4. Ensure repairs are made by qualified personnel using approved parts. [4]

[4]

Documentation Requirements

Maintain records of all inspections, repairs, and maintenance performed on duct jacks. [3]

Checklist Completion

Overall Status: ☐ Pass     ☐ Fail     ☐ Corrective Actions Required

Inspector Signature: Date:

Supervisor Review: Date:

Corrective Actions Completed By: Date:

References and Standards

  • 29 CFR 1910\.244 - Jacks
  • 29 CFR 1926\.305 - Jacks, levers, and blocking

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

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4 source record(s)

Sources used for this answer

[1] Hydraulic Jack Inspection Checklist

Page 1

Open source document

Source excerpt

# JACK INSPECTION REPORT # (TOWN DEPARTMENT) DATE: JACK # <table><tr><th>1. Do jacks in use have a rating sufficient to lift and sustain the loads? [29 CFR 1910.244(a)(1)(i)]</th><th>Y N</th><th>N/A</th></tr><tr><td>2. Is the rated load legibly and permanently marked in a prominent location on the jack by casting, stamping, or other suitable means? [29 CFR 1910.244(a)(1)(ii) and 1926.305(a)(1)]</td><td>Y N</td><td>N/A</td></tr><tr><td>3. Do all jacks have a positive stop to prevent over-travel? [29 CFR 1926.305(a)(2)]</td><td>Y N</td><td>N/A</td></tr><tr><td>4. Are hydraulic jacks that are exposed to freezing temperatures supplied with adequate antifreeze liquid? [29 CFR 1910.244(a)(2)(iv) and 1926.305(d)(1)(ii)]</td><td>Y N</td><td>N/A</td></tr><tr><td>5. Are all jacks properly lubricated at regular intervals? [29 CFR 1910.244(a)(2)(v) and 1926.305(d)(1)(iii)]</td><td>Y N</td><td>N/A</td></tr><tr><td>6. Is each jack thoroughly inspected? [29 CFR 1910.244(a)(2)(vi) and 1926.305(d)(1)(iv)]</td><td>Y N</td><td>N/A</td></tr><tr><td>7. Are jacks that are used constantly or intermittently at one locality thoroughly inspected at least every six months? [29 CFR 1910.244(a)(2)(vi)(a) and 1926.305(d)(1)(iv)(a)]</td><td>Y N</td><td>N/A</td></tr><tr><td>8. Are jacks that are sent out thoroughly inspected when they are returned? [29 CFR 1910.244(a)(2)(vi)(b) and 1926.305(d)(1)(iv)(b)]</td><td>Y N</td><td>N/A</td></tr><tr><td>9. Are jacks that are subjected to abnormal load or shock thoroughly inspected immediately before and immediately after use? [29 CFR 1910.244(a)(2)(vi)(c) and 1926.305(d)(1)(iv)(c)]</td><td>Y N</td><td>N/A</td></tr><tr><td>10. Are repair or replacement parts examined for defects? [29 CFR 1910.244(a)(2)(vii) and 1926.305(d)(1)(v)]</td><td>Y N</td><td>N/A</td></tr><tr><td>11. 15. Are repairs made on disabled jacks before they are used again? [29 CFR 1910.244(a)(2)(viii) and 1926.305(d)(1)(vi)]</td><td>Y N</td><td>N/A</td></tr></table>

[2] Checklist for Respiratory Maintenance and Care

Page 2

Open source document

Source excerpt

# CHECKLIST FOR RESPIRATORY MAINTENANCE AND CARE (cont.) ## Inspections (cont.) SCBAs and emergency respirators are inspected monthly and checked for proper function before and after each use. - Inspections include: - Check for respiratory function. - Tightness of connections. - Condition of the facepiece, head straps, valves and cartridges. - Condition of elastomeric parts. - For SCBAs, inspection includes checking that cylinders are fully charged, and that regulators and warning devices function properly. - Emergency use respirators are certified by documenting the inspection, and by tagging the information either to the respirator or its compartment, or storing it with inspection reports. ## Repairs Respirators that have failed inspection are taken out of service. Repairs are made only by trained personnel. Only NIOSH-approved parts are used. Reducing and admission valves, regulators and alarms are adjusted or repaired only by the manufacturer or a technician trained by the manufacturer.

[3] Self-inspection checklist: Recordkeeping

Page 1

Open source document

Source excerpt

Self-inspection checklist ## Recordkeeping Are all occupational injuries and illnesses, including those involving loss of life, loss of consciousness, loss of time from work, and those requiring treatment other than first aid, recorded as required on the OSHA Form 300? Are copies of OSHA Form 300 and First Report of Injury, Form 801, kept for five years? Are employee's medical records and records of exposure to hazardous substances or harmful physical agents current? Have arrangements been made to maintain required records for the legal period for each type of record? (Some records must be maintained for at least 40 years.) Are operating permits and records current for elevators, pressure vessels, and liquefied petroleum gas tanks? Are employee safety and health training records maintained? Are safety inspections and corrections documented and maintained?

[4] Facility Safety Inspection Form

Page 1

Open source document

Source excerpt

# Facility Safety Inspection Form <table><tr><th>Are the following conditions present at the worksite?</th><th>Yes</th><th>No</th><th>N/A</th><th>Source</th></tr><tr><td>1. Fumes or Vapors</td><td></td><td></td><td></td><td></td></tr><tr><td>2. Dust</td><td></td><td></td><td></td><td></td></tr><tr><td>3. Excessive heat or cold</td><td></td><td></td><td></td><td></td></tr><tr><td>4. Heights</td><td></td><td></td><td></td><td></td></tr><tr><td>5. Noise or vibration</td><td>וחוח</td><td></td><td></td><td></td></tr><tr><td>6. Underground work</td><td></td><td></td><td></td><td></td></tr><tr><td>7. Sufficient lighting</td><td></td><td></td><td></td><td></td></tr><tr><td>Housekeeping</td><td>Yes</td><td>No</td><td>N/A</td><td>Comments</td></tr><tr><td>8. Are aisles clearly marked and unobstructed?</td><td></td><td></td><td></td><td></td></tr><tr><td>9. Are workstations cluttered or crowded?</td><td></td><td></td><td></td><td></td></tr><tr><td>10. Are materials store in identified areas?</td><td></td><td></td><td></td><td></td></tr><tr><td>11. Is there paper, plastic wrap, parts, or any other object that could cause slips/falls on the floor?</td><td></td><td></td><td></td><td></td></tr><tr><td>12. Are the floors free of spills or liquids?</td><td></td><td></td><td></td><td></td></tr><tr><td>Machines</td><td>Yes</td><td>No</td><td>N/A</td><td>Comments</td></tr><tr><td>13. Does equipment have proper guarding? (Look for pinch points, exposed rotating, moving parts, etc)</td><td></td><td></td><td></td><td></td></tr><tr><td>14. Are emergency stop buttons readily accessible to the operator?</td><td></td><td></td><td></td><td></td></tr><tr><td>15. Are machine operators trained in proper use methods?</td><td></td><td></td><td></td><td></td></tr><tr><td>16. Are training methods documented?</td><td></td><td></td><td></td><td></td></tr><tr><td>Which Personal Protective Equipment pieces are required?</td><td>Yes</td><td>No</td><td>N/A</td><td>Comments</td></tr><tr><td>17. Safety glas…

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