Graphite Lift Plug

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Unit information

• Mfg. Date

• Last Recertification Date

• Part Number

• Serial Number

Inspection items

• Is the Bail in acceptable condition?

  Ok

  Not Acceptable

• What is wrong with the Bail?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add photo if Possible

  Media

• Is the Graphite Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Graphite?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

• Are the Bolts Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Bolts?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

• Are the Nuts Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Nuts?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

• Is the Top Plate Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Top Plate?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

• Is the Bottom Plate Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Bottom Plate?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

• Are the Tags Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Tags?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

• Are the Welds Acceptable?

  Ok

  Not Acceptable

• What is wrong with the Welds?

  Select Bent Gaulded/Arc Burns Gouged Stretched Missing Worn Other

  • Bent
  • Gaulded/Arc Burns
  • Gouged
  • Stretched
  • Missing
  • Worn
  • Other

• Explain Other response and what is the recommendations?

• Add Photo if Possible

  Media

Additional information

• Notes and Recomendations

• Add any Photos that would help explain issues

  Media