LEVER HOIST INSPECTION REPORT & TEST REPORT

CUSTOMER DETAILS

CUSTOMER

Date

ADDRESS

ORDER NO

CONTACT

TEL NO:

DESCRIPTION OF LIFTING MACHINERY

Unit:

SERIAL NO:

WLL:

LENGTH/SIZE/REACH

PLANT

LOCATION:

LAST INSPECTION *

NEXT INSPECTION *

EQUIPMENT CONDITION

NAME PLATE / ID/MARKINGSGOODFAIRBAD

Name Plate / Id/Markings Remarks

LOAD WHEELS/ROLLERSGOODFAIRBAD

Load wheels/rollers Remarks

LOAD WHEEL BEARINGSGOODFAIRBAD

Load wheel bearings Remarks

SIDE PLATESGOODFAIRBAD

Side Plates Remarks

SHAFT/SGOODFAIRBAD

Shaft/s Remarks

DRIVE SHAFTGOODFAIRBAD

Drive Shaft Remarks

SPACERSGOODFAIRBAD

Spacers Remarks

SUSPENSION EYE/HOOK ANCHORGOODFAIRBAD

Suspension Eye/Hook Anchor Remarks

GEARSGOODFAIRBAD

Gears Remarks

HAND/MESSENGER CHAINGOODFAIRBAD

Hand/Messenger Chain Remarks

HAND WHEELGOODFAIRBAD

Hand Wheel Remarks

NOTES

NOTES:

INSPECTION/ TEST RESULTS

Visual InspectionYESNO

RESULTS (Pass or Fail)PASSFAIL

TEST (for Test Certificate)YESNO

SERVICE RENDEREDINSPECTIONTEST

SIGN AND SUBMIT

INSPECTOR NAME & SURNAME

WORK TITLE

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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

Consent

I Hereby Certify That The Abovementioned Equipment Has Been Inspected In Accordance With The Applicable Standards And Is Safe For Use.