RECORD OF TECHNICAL SAFETY INSPECTION FOR OVERHEAD LIFTING EQUIPMENT
(Superior organization)
(Name of the inspection organization)
SOCIALIST REPUBLIC OF VIETNAM
Independence – Freedom - Happiness
.........… date: ... ... ...
RECORD OF TECHNICAL SAFETY INSPECTION
(FOR OVERHEAD LIFTING EQUIPMENT)
No. …
The participants include:
1………Inspector’s number: ………
1………Inspector’s number: ………
Inspection organization: ………
Inspection organization’s registered certificate number: ………
Name of the equipment inspected: ………
Name of the requester:
Address (head office):
Address (location) of equipment installation:
Inspection procedure and standards applied: ………
Individuals witnessing and ratifying the record: ………
1...................................................... Position: ………
2...................................................... Position: ………
I. BASIC PARAMETERS OF THE EQUIPMENT
- Code: ………… - Trolley speed: … meter/ minute
- Production number: … - Bridge speed: … meter/ minute
- Year of production: … - Aperture, cantilever: ... m
- Manufacturer: ... - Height of lift (main and auxiliary hooks): … m
- Intended load capacity: … ton - Load capacity at cantilever's end: … ton
- Lifting speed: ... meter/ minute - Function: ...
II. FORM OF INSPECTION
First time □ Periodic □ Random □
III. DETAILS OF INSPECTION:
A. Inspection of technical documents:
- Remark: ………
- Assessment of findings:
B. External inspection and no-load test
- Remark: ………
- Assessment of findings:
C. Load test
- Remark: ………
- Assessment of findings:
IV. CONCLUSION AND RECOMMENDATION
1. The equipment inspected is: Qualified □ Unqualified □
to operate with the maximum load of … ton
2. Inspection stamp no … Stamp position: ...
3. Recommendation:
Time limit for implementation of recommendations: …
V. INSPECTION SCHEDULE
The following inspection shall be scheduled for ... [date]
Reason for early inspection schedule (if applicable): …
The record was ratified on … [date]
At: …
The record is made into ... originals. Each party keep ... original(s)
The inspectors assume all liabilities for the accuracy of remark and assessments in this record./.
EQUIPMENT USER
(Sign and append corporate seal)
(Undertaking to fulfill recommendations in timely manner)
WITNESS
(Sign and append full name)
INSPECTOR
(Sign and append full name)