FORKLIFT INSPECTION & TEST REPORT

CUSTOMER DETAILS

CUSTOMER

Date

ADDRESS

ORDER NO

CONTACT

TEL NO:

Description of Lifting Machinery

UNIT:

SERIAL NO:

WLL:

Reach/Length/Size:

MODEL:

HOURS:

PLANT

LOCATION:

PREVIOUS INSPECTION DATE *

NEXT INSPECTION DATE *

EQUIPMENT CONDITION

Data Plate / ID MarkingsGOODFAIRBAD

Data Plate / ID Markings Remarks

Gauges & InstrumentsGOODFAIRBAD

Gauges & Instruments Remarks

MastGOODFAIRBAD

Mast Remarks

Chains & MountingGOODFAIRBAD

Chains & Mounting Remarks

RollersGOODFAIRBAD

Rollers Remarks

Forks / Attachment/sGOODFAIRBAD

Forks / Attachment/s Remarks

Load Back RestGOODFAIRBAD

Load Back Rest Remarks

TransmissionGOODFAIRBAD

Transmission Remarks

Engine / Motor/s (Filters, Batteries, Levels)GOODFAIRBAD

Engine / Motor/s (Filters, Batteries, Levels) Remarks

Pedals & FittingsGOODFAIRBAD

Pedals & Fittings Remarks

Radiator & FanGOODFAIRBAD

Radiator & Fan Remarks

Collant, Pump & HosesGOODFAIRBAD

Collant, Pump & Hoses Remarks

Hydraulic System (Cylinders,Hoses,Level)GOODFAIRBAD

Hydraulic System (Cylinders,Hoses,Level) Remarks

ElectricalsGOODFAIRBAD

Electricals Remarks

Keys, Ignition & StarterGOODFAIRBAD

Keys, Ignition & Starter Remarks

LeversGOODFAIRBAD

Levers Remarks

Steering Column/KnobGOODFAIRBAD

Steering Column/Knob Remarks

Service & Parking BreakGOODFAIRBAD

Service & Parking Break Remarks

HornGOODFAIRBAD

Horn Remarks

Strobe LightGOODFAIRBAD

Strobe Light Remarks

Service Lights (Head, Indicators Etc)GOODFAIRBAD

Service Lights (Head, Indicators Etc) Remarks

Reverse WarningGOODFAIRBAD

Reverse Warning Remarks

Seat & Seat BeltGOODFAIRBAD

Seat & Seat Belt Remarks

Overhead GuardGOODFAIRBAD

Overhead Guard Remarks

Counter WeightsGOODFAIRBAD

Counter Weights Remarks

Gas Bottle & BracketGOODFAIRBAD

Gas Bottle & Bracket Remarks

Tyres, Rims & NutsGOODFAIRBAD

Tyres, Rims & Nuts Remarks

NOTES

NOTES:

Visual InspectionYESNO

TestYesNo

RESULTS

RESULTSPASSFAIL

INSPECTOR NAME & SURNAME

POSITION/ TITLE;

CERTIFIED BY

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CUSTOMER REPRESENTATIVE:

CUSTOMER REPRESENTATIVE

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Consent *

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

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This Is To Certify That The Below Mentioned
Lifting tackle has been Examined/Inspected And/Or Tested Accordance With SANS 10388 And Meets Safety Standards In Accordance With The OHS Act And The MHS Act.