Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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E-Stop Functional and Undamaged
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Handset and buttons functional and undamaged
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Support wires and decals in good condition
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Dual speed buttons functional
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Top and bottom hoist limits functional
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Safety catch on hook in place and spring functional
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Anti collision device in full working order
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OHC comes to rest smoothly in reasonable time
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Lifting tackle in compliance with SWP100
Sign Off
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Team Leader Signature