Title Page
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Site conducted
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Conducted on
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Prepared by
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Equipment Serial Number
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Legible Capacity Tag Fitted
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Anvil Free Of Damage
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Ratchet Paw Free of Damage or Excessive Wear
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Pins Free of Damage or Excessive Wear
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Lift Points Free of Damafe
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Frame Not Bent or Warped
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Jack Operates as Designed
Completion
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Stand Safety Outcome
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Signature