CHAIN BLOCK INSPECTION

CUSTOMER DETAILS

CUSTOMER

Date

ADDRESS

ORDER NO

CONTACT

TEL NO:

DESCRIPTION OF UNIT

UNIT:

SERIAL NO:

WLL:

LENGTH/SIZE/REACH

PLANT

LOCATION:

PREVIOUS INSPECTION DATE *

NEXT INSPECTION DATE *

EQUIPMENT CONDITION

NAME PLATE / ID/MARKINGSGOODFAIRBAD

Remarks

TOP HOOK & LATCHGOODFAIRBAD

Remarks

TOP HOOK PINGOODFAIRBAD

Remarks

CHAIN ROLLER/GUIDEGOODFAIRBAD

Remarks

GEAR COVER & BUSHESGOODFAIRBAD

Remarks

SIDE PLATES & BOLTSGOODFAIRBAD

Remarks

LOAD SHEAVEGOODFAIRBAD

Remarks

BRAKE COVERGOODFAIRBAD

Remarks

HAND/MESSENGER CHAINGOODFAIRBAD

Remarks

HAND/MESSENGER CHAIN WHEEL COVERGOODFAIRBAD

Remarks

HAND/MESSENGER CHAIN WHEELGOODFAIRBAD

Remarks

CHAIN ANCHORGOODFAIRBAD

Remarks

PINION SHAFT NUTGOODFAIRBAD

Remarks

LOAD CHAINGOODFAIRBAD

Remarks

CHAIN DEAD ENDGOODFAIRBAD

Remarks

BOTTOM HOOK & LATCH (ASSEMBLY)GOODFAIRBAD

Remarks

DISC HUBGOODFAIRBAD

Remarks

GEARS (LOAD/PINION)GOODFAIRBAD

Remarks

PAWL & SPRINGSGOODFAIRBAD

Remarks

RATCHETGOODFAIRBAD

Remarks

LOAD TEST ITEM

TOP HOOKGOODFAIRBAD

Remarks

BOTTOM HOOKGOODFAIRBAD

Remarks

LOAD CHAINGOODFAIRBAD

Remarks

FRICTION PLATES/DISCSGOODFAIRBAD

Remarks

LOAD SHEAVEGOODFAIRBAD

Remarks

HAND/MESSENGER CHAIN ASSYGOODFAIRBAD

Remarks

NOTES

NOTES:

INSPECTION/ TEST RESULTS

Visual InspectionYESNO

RESULTSPASSFAIL

TEST (for Test Certificate)YESNO

SERVICE RENDEREDINSPECTIONTEST

SIGN AND SUBMIT

INSPECTOR NAME & SURNAME

POSITION/ TITLE;

CERTIFIED BY

Start signing your signature here

CUSTOMER REPRESENTATIVE:

CUSTOMER REPRESENTATIVE

Start signing your signature here

Consent *

THE CUSTOMER ACKNOLEDGES THAT DEFECTIVE EQUIPMENT WILL NOT BE USED UNTIL REPAIRS ARE DONE AND THE UNIT IS INSPECTED AND/OR TESTED

HTML

This Is To Certify That The Below Mentioned
Lifting tackle has been Examined/Inspected And/Or Tested Accordance With SANS 509:2007 And Meets Safety Standards In Accordance With The OHS Act And The MHS Act.