Title Page
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CUSTOMER:
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DATE:
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JOB #/P.O. #
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CUSTOMER EQUIPMENT I.D.
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AREA/LOCATION:
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INSPECTED BY:
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ANC#
Equipment Info & Inspection Section
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MFG :
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SER #
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MOD #
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CAPACITY :
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CAPACITY ?
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EQUIPMENT TYPE :
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TYPE=
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TYPE OF INSPECTION: (Annual) (Quarterly) (Monthly)
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Hook Retaining Hardware Loose
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Hook Cracks
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Hook Excessive Wear
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Hook Bent more than 10 degrees
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Hook Freely Rotating
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Hook Latch Damaged
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Brake Worn/Not Operating
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Brake Excessive Drift
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Brake Excessive Disk Wear
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Overload Device Operating Properly [Limit Clutch]
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Chain Excessive Wear
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Chain Worm Guides
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Chain Binding
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Chain Cracked
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Chain Twisted
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Chain Distorted
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Chain Corroded
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All Points Lubricated [Per Mfg. Spec]
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Warning Labels Missing
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Warning Labels Illegible
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Pocket Wheels Worn Excessively
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Lubrication of Gears, Chains, sprockets. pins and axles
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Hoist /Trolley Operation
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Trolley, Monorail, and supporting structure
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Housing Loose Hardware
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EQUIPMENT CONDITION AND OPERATION SAFE FOR NORMAL USE?
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EQUIPMENT NEEDS REPAIRS ?
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EQUIPMENT SHOULD BE "TAGGED OUT" AND NO LONGER USED UNTIL REPLACED OR REPAIRED?
