MATERIALS HOIST INSTALLATION/HANDOVER CERTIFICATE

• Site conducted

  Select

• Date/Time:

  Date

• Client

• Site:

• HMS Contract # (5 digits):

• Hoist Number (SRG Asset #):

• Model #:

• Serial #:

• # Landings:

• Platform SWL (kg):

• Installed by:

• Checked By:

HOIST BASE

• 1.1 Area under hoist is level, firm and stable ?

  Yes

  No

  N/A

• 1.2 Are foundations sound to withstand the total mass of the hoist?

  Yes

  No

  N/A

• 1.3 Area around the hoist base and loading ramp clear and free from obstructions?

  Yes

  No

  N/A

• 1.4 Clearance between hoist and structure is 50mm-150mm maximum?

  Yes

  No

  N/A

• 1.5 Driving pinion free from excess wear, has no missing teeth and is lubricated ?

  Yes

  No

  N/A

• 1.6 Cable drum is secured and not in line-of-fire of hoist platform ?

  Yes

  No

  N/A

PLATFORM

• 2.1 SWL displayed on hoist platform (Kgs)?

  Yes

  No

  N/A

• 2.2 All stickers / signage on hoist platform clear, legible and in good condition ?

  Yes

  No

  N/A

• 2.3 Manufacturer installed safety components and features present, functional and unmodified?

  Yes

  No

  N/A

• 2.4 Platform guard railing as per manufacturer's specifications ?

  Yes

  No

  N/A

• 2.5 Fold down ramps functional and secured adequately via the safety latch ?

  Yes

  No

  N/A

MAST SECTIONS

• 3.1 Bolts joining mast sections are in place and secured ?

  Yes

  No

  N/A

• 3.2 Rack on mast sections adequately lubricated ?

  Yes

  No

  N/A

• 3.3 Teeth on rack in good condition / no teeth missing ?

  Yes

  No

  N/A

BRACING / TIES

• 4.1 Bracing placed at intervals per the manual ?

  Yes

  No

  N/A

• 4.2 Scaffolding tube and couplers used for hoist bracing / ties fit for purpose and adequately secured / tightened ?

  Yes

  No

  N/A

• 4.3 Mast sections are vertically aligned after bracing and ties have been placed ?

  Yes

  No

  N/A

• 4.4 Hoist supporting structure able to sustain the forces produced by the hoist and loads ?

  Yes

  No

  N/A

• 4. No more than 4m of unsupported mast present at the top of the hoist ?

  Yes

  No

  N/A

GENERAL

• 5.1 Client shown operating instructions and location ?

  Yes

  No

  N/A

• 5.2 Client supplied with copy of hoist logbook ?

  Yes

  No

  N/A

• 5.3 Emergency stops fitted, tested and operational ?

  Yes

  No

  N/A

• 5.4 Hoist gates provided at all landings ?

  Yes

  No

  N/A

• 5.5 Limit switches fitted and functional ?

  Yes

  No

  N/A

• 5.6 Overspeed governor (emergency brake) fitted, tested and operational?

  Yes

  No

  N/A

• 5.7 Safety interlocks fitted, tested and functional (where applicable) ?

  Yes

  No

  N/A

• 5.8 Trailing cable guides fitted at intervals of not more than 6m ?

  Yes

  No

  N/A

• 5.9 Trailing cable is spooling into drum correctly ?

  Yes

  No

  N/A

• 5.10 Trailing cable free from cuts or damage and in good condition ?

  Yes

  No

  N/A

• 5.11 Fault lights on control box tested and functional ?

  Yes

  No

  N/A

• 5.12 Hoist pendent control tested and functional ?

  Yes

  No

  N/A

• 5.13 Overload, brake, and drop tests conducted ?

  Yes

  No

  N/A

• 5.14 Entire travel path of hoist platform has been test run to ensure there is no interference with supporting structure ?

  Yes

  No

  N/A

• 5.15 Hoist electrical tag fitted and in date ?

  Yes

  No

  N/A

• 5.16 Check to make sure that there is no access landings where the hoist car passes that there is the possibility of coming in contact with the hoist car or any moving parts?

  Yes

  No

  N/A

COMMENTS

• undefined

SIGNATORY

• I hereby certify that I have examined and tested as appropriate the above mentioned equipment and I find that the equipment is in conformance with the relevant parts and sections of AS 1418 and AS 2550. I find that at the time of examination and tested the equipment is in satisfactory condition for safe use.

• SRG Employee:

  Sign

• Client Representative:

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