Record of technical safety inspection (for mobile crane)

RECORD OF TECHNICAL SAFETY INSPECTION

(FOR MOBILE CRANE)

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

II. FORM OF INSPECTION

First time □, periodic □, random □

III. DETAILS OF INSPECTION:

A. Document inspection:

B. External inspection and no-load test:

C. Load test

IV. CONCLUSION AND RECOMMENDATION

1. The equipment inspected is: Qualified □ Unqualified □

2. Inspection stamp n^o … affixed at …

3. The equipment is functionally qualified for the maximum load of … ton at an equivalent radius of … meter

4. Recommendations:

Time limit for implementation of recommendations: …

V. INSPECTION SCHEDULE

Periodic inspection: …. [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./.