Information
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Crane#
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Document No.
Description
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Inspection Date/Time
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Employee Performing Report
- Windsor,Grant
- Bertrand,Danny
- Tasse,Martin
- Gauthier,Pierre
- Chamberlain,Corey
- Gravelle,Marc
- Landreville,Pat
- Gravelle,Denis
- Sved,Frank
- OTHER
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Last Name,First Name
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Unit
- #77 National BT
- #28 Grove TM300
- #29 Grove TMS300B
- #32 Grove TMS865
- #36 Liebherr LTM1090
- #39 Liebherr LTM1120-1
- #40 Liebherr LTM1300-1
- #41 Liebherr LTM1100-4.1
- #37 Grove TMS700E
- #38 Grove TMS700E
- #76 Kenworth
- #81 Freightliner
- #84 Kenworth
- #56 Flatbed Trailer
- #81 Freighliner
- #86 Homemade Trailer
- #85 Fontain Trailer
- #83 Float Trailer
- #82 TuscoLB Trailer
- #56 Flatbed Trailer
- #50 Stepdeck trailer
- #3 29'Float trailer
- CP-CentrePost Basket
- AB-Aluminium Basket
- #70 Int. 5t Flatbed
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National Boomtruck
Unit# 77
S/N 1FDZY90T2PVA17406 -
Grove TMS300
Unit# 28
S/N 45887 -
Grove TMS300B
Unit# 29
S/N KN15527008 -
Grove TMS865
Unit# 32
S/N DJ1W18007 -
Liebherr LTM1090/1
Unit# 36
S/N 0022011 -
Grove 700E
Unit# 37
S/N 222064 -
Grove 700E
Unit# 38
S/N 222280 -
Liebherr LTM1120/1
Unit# 39
S/N 0023759 -
Liebherr LTM1300/1
Unit# 40
S/N W096760002EL05113 -
Liebherr LTM1100-4.1
Unit# 41
S/N 063377 VIN:W094747006EL05128 -
Kenworth T80, 1999
Unit# 76
S/N 1XKDDB9X7XJ955985 -
Freightliner, 2006
Unit# 81
S/N 1FUJA6CK26LW44455 -
Kenworth, 1996
Unit# 84
S/N 1XKDD69X3TJ682996 -
2006,Freghtliner
Unit# 81
S/N 1FUJA6CK26LW44455 -
Trailer,Flatbed, 1992
Unit# 56
S/N 150850602 -
1985,Tusco Low Bow
Unit# 82
S/N 2T9TC5039F4001545 -
1979,Float
Unit# 83
S/N 2SAAQM39210050220 -
2001,Fontain
Unit# 85
S/N 4LF4R483713511160 -
1981,Stepdeck
Unit# 50
S/N 2A45802213 -
1972,Float
Unit# 3
16138 -
CentrePost Basket
Yellow Square Construction -
AB-Aluminium Basket
PLAN: MB102886-1250
S/N 5157 Norcan Aluminium -
1990, International
#70 5t Flatbed
1HTSCCFP6LH658050 -
Odometer
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Hours
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What type of Report
- Pre-Trip Inspection
- Elevated Work Platform
- Yearly Inpsection
- Being Serviced
- Damage Report
- Incident Report
TO BE COMPLETED BY THE OPERATOR (COMPETENT PERSON O.Reg. 631/94, s.4.)
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WHAT HARNESS BAG ARE YOU SIGNING OUT?
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This Basket appears to have been constructed in accordance with the design drawings O.Reg. 631/94, s.4.
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Crane log, containing structural elements has been completed and is satisfactory O.Reg. 631/94, s.4.
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All rigging and accessories used with the basket have been visually inspected and appear satisfactory O.Reg. 631/94, s.4.
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There is an adequate means of communication (hand signals, radios or other) with the personel in the basket O.Reg. 631/94, s.4.
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I have received adequate instructions about the requirements, restrictions and hazards associated with the hoisting operation on this site O.Reg. 631/94, s.4.
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I have read and understood the emergency rescue procedures below (or attached) to this audit O.Reg. 631/94, s.4.
EMERGENCY RESCUE PROCEDURE
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In Case of Emergency, Crane Operator:
1. Lower Personel to Safety Immediately. CALL 911. Call for Supervisor
2. If Unable to Lower, Stabilize Crane and CALL 911
Personel in Basket
1. Remain Calm. Follow Instructions from the Ground Crew
Pre-Trip Inspection
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Crane or Tractor/Trailer
General
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1. Operator's Manual and Load Charts
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3. Mirrors and Horns
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5. Fire Extinguishers and Emergency Equipment
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7. Lights
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9. Windshield Wipers and Defrosters
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11. Electrical System / Batteries
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13. Cooling System and Fluid
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15. Fuel System
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17. Engine Oil and Filters
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19. Gauges
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21. Torque Converters
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23. Cylinders and Hydraulic Systems
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25. Oil Leaks
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27. Lubrication
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29. Engine Oil, Coolant, Fuel Levels
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31. Hoses/ Belts
Carrier/Deck
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61. Tires and Wheel Lugs
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63. Suspension System
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65. Braking System (Pumps, Reservoirs, Filters)
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67. Steering System
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69. Carrier Frame, Cab, Body
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71. Outrigger Boxes, Beams, Cylinders, Pads, Pins
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72. Load Securement-Cargo is Secure
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73. All Securement Devices or Load Coverings are Present and Not Malfunctioning or Deteriorated
Crane Upper
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33. Boom Angle Indicator
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35. Boom Length Indicator
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37. Two-Block Warning Device
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39. Load Indicator
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41. Drum Rotation Sensor
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43. Engine Throttle and Controls
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45. Swing Controls, Clutches, Brakes
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47. Swing Lock
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49. Boom Hoist Controls, Clutches, Brakes
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51. Main Drum Controls, Clutches, Brakes
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53. Auxiliary Drum Controls, Clutches, Brakes
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55. Propel Control, Clutches, Brakes
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57. Master Clutch
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59. Machinery Guards
Ropes and Accessories
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75. Main and Auxiliary Hoist Ropes
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77. Sheaves, Rollers, Equalizers
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79. Rope Anchorage on Drums
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81. Cablekeepers on all Sheaves
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83. Hooks and Blocks
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Other/Description
Yearly Inspection
Unit in Service
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Description of Service
Damage Report
Incident Report report any incident in which a crane became unstable, Dulepka employees or site personel where endangered, or where significant damage could have occurred.
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Date & Time of Incident
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What was the nature of the incident
- Crane Instability
- Personel Endangered
- Significant Property Damage
- OTHER
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Describe OTHER
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Person(s) Involved (other, identify in description)
- Windsor,Grant
- Bertrand,Danny
- Tasse,Martin
- Gauthier,Pierre
- Chamberlain,Corey
- Gravelle,Marc
- Landreville,Pat
- Gravelle,Denis
- Sved,Frank
- OTHER
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Relevant Pictures
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Describe
SignOff
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Signature
