EMV Inspection Report

• Client / Site

• EMV being inspected

• Conducted on

  Date
• Location
  Address

1. Equipment

• Is the Equipment free of excessive dirt and/or debris?

  Yes

  No

  N/A

• Is the Equipment free of damage?

  Yes

  No

  N/A

• Adaptor Bracket (yoke)

  Pass

  Fail

  N/A

• Adjustable Quick Hitch Bracket

  Pass

  Fail

  N/A

• Shear Pin / Lifting Bolt

  Pass

  Fail

  N/A

• Bushes and Spacers

  Pass

  Fail

  N/A

• ( 12 ) Sandwich Mounts / Bolts

  Pass

  Fail

  N/A

• ( 9 ) Buffer Stops

  Pass

  Fail

  N/A

• ( 1 ) Saddle Assembly

  Pass

  Fail

  N/A

• Boss, Gap and Grease

  Pass

  Fail

  N/A

• Gear Box Oil (visual)

  Pass

  Fail

  N/A

• ( 16 ) Gearbox

  Pass

  Fail

  N/A

• ( 22 ) Sub-Gearbox Bolts / Nordlock Washers

  Pass

  Fail

  N/A

• ( 5 ) Motor / Blow Off Valve (visual)

  Pass

  Fail

  N/A

• ( 7 ) Breather Valve (visual)

  Pass

  Fail

  N/A

• Hydraulic Hoses x 3

  Pass

  Fail

  N/A

• Hydraulic Hose Caps x 3

  Pass

  Fail

  N/A

• EMV Hoses and Fittings

  Pass

  Fail

  N/A

• Oil Leaks

  Pass

  Fail

  N/A

• ( 18 ) Clamp Assembly

  Pass

  Fail

  N/A

• ( 11 ) Moving Jaw and Bolts

  Pass

  Fail

  N/A

• ( 10 ) Static Jaw and Bolts

  Pass

  Fail

  N/A

• ( 21 ) Lifting Chain

  Pass

  Fail

  N/A

• ( 20 ) Chain Clamp

  Pass

  Fail

  N/A

• ( 21 ) Stickers, Decals and Paint Condition

  Pass

  Fail

  N/A

9. Summary

• Comments

• Supervisor signature

  Sign