Record of technical safety inspection (for forklift)

RECORD OF TECHNICAL SAFETY INSPECTION

(FOR FORKLIFT)

RECORD OF TECHNICAL SAFETY INSPECTION

(FOR FORKLIFT)

No. …

The participants include:

1. Inspector’s number: …

2. 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

- Type and code: … - Fork size: … mm

- Production number: … - Lift height: … mm

- Year of production: … - Lift speed: … meter/ minute

- Manufacturer: ... - Travel speed: … kilometer/ hour

- Power source: … - Load center distance at maximum load: … mm

- Working / intended load: … /… kg- Function: …

II. FORM OF INSPECTION

First time □, periodic □, random □

III. DETAILS OF INSPECTION:

A. Inspection of technical documents:

B. External inspection and no-load test:

C. Load test

IV. CONCLUSION AND RECOMMENDATION

1. The equipment inspected is: Qualified □ Unqualified □

to operate at the maximum load of … ton, with the equivalent load center distance of … mm

2. Inspection stamp n^o …was affixed at … of the forklift3. Recommendations:

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 conducting the inspection assume all liabilities for the accuracy of remarks and assessments in this record./.