Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

SRL (Latchway/MSA)

  • SRL sticker present & in date

  • SRL serial number

  • SRL secure and undamaged

  • SRL Frame free for damaged

  • SRL Run smoothly when carrying out pull out test

  • SRL been deployed

  • is tether line present

Davit crane Palfinger 14000

  • Davit crane service sticker present and in date

  • ID plate present

  • Lower pedestal bolts Painted or Denso taped

  • Crane wire Greased

  • Coating damage to any area of the davit crane

  • MOPS handle present and free from damage

  • Electrical cabinets free from damage and water ingress

  • Pedestal remote present and free from damage

  • External power source present with cap fitted

  • Emergency stop present and free from damage

  • Rescue arm present and free from damage

Concrete platform

  • General condition (Cracks, Surface Defects etc)


  • coating damage


  • Handrails free from damage

  • Handrails secure and free from movement

  • Securing pot pins in place and tethered

  • Handrail housing pot free from damage (Welds Cracked)

  • Handrail sit flush in housing pot

Loading gates

  • Gates free from damage

  • Locking mechanism function correctly

  • Locking mechanism retaining wire & split pin in place

  • Locking mechanism have rubber pads in place

  • Are the loading gates meant to be self-closing?

  • Individual gate securing pin fit in hole

  • Gate hinge greased

Access gate

  • Main access gate are they self-closing

  • Sign's of rust

Temporary nav lights

  • Installed

Anchor point

  • Anchor point have ID Plates

  • Do they have a SWL

  • Signage clear. Eg, two person hook on or one person


  • Cover secure and free from damage

  • Access point open freely

GBS Internal

  • SRL Bracket installed

  • SRL installed

  • Access ladder free from damage

  • Top hat anchor straps in place and secure

  • Gratings free from damage

  • Mushrooms installed and secured

  • Lower access hatch in place and free from damage

  • Locking chain in place for access hatch and free from damage

  • Switch gear in place and free from damage

  • Switch gear have a cover over it

  • Lighting in place and free from damage

  • Safety signage installed and clear

  • Handrails secure and free from damages

  • Access gates self-closing and free from damage

  • Cable trays installed and free from damages

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.