UNIVERSAL TRADING & INDUSTRIAL SERVICES INC.

MOBILE CRANE INSPECTION

CLIENT EQUIPMENT OWNER INSPECTION DATE CAPACITY MANUFACTURER SERIAL NO. MODEL NO. DATE MANUFACTURED MAINTENANCE RECORD SERVICE RECORD PREVIOUS INSPECTION RECORD NAME OF INSPECTOR(S) INSPECTION FREQUENCY : : : : : : : : : : : : : : ASSESSMENT REMARKS

SAFETY INSPECTION PARTICULARS Driver Cab 1 Electrical Gauges 2 Electrical Horn 3 Headlight Signals 4 Mirror/Windshield 5 Cutrigger Support 6 Tires/Wheels 7 Obstruction 8 Engine Condition Crane Compartment 1 Load Indication Chart 2 Instrument Gauges 3 Handholds/Guards Rails/Protective Structure 4 Limit Switch 5 Over Load Device 6 Brake 7 Hook & Block 8 Engine Condition Boom 1 Boom Angle Indicator 2 Boom Rest 3 Boom Structure Condition 4 Condition of Laces 5 Bolt Firmly Tightened 6 Keys/Splits pins not detached/Bossened Wire Rope & Sheaves 1 Lubrication 2 Condition Rope 3 Sheaves/Tight/Frozen 4 Wedge Suck Clips Drums Assemly 5 Line Pull 6 Rope Reeving 7 Rope Spooling 8 Rope Guide 9 Safety Latch Provided 10 Type of Rope 11 Size 12 Hook One Block page 1 of 3

SAFETY INSPETION ITEMS Electrical Accessories 1 Spot Lights 2 Horn 3 Windshield Wiper 4 Mirror/Windshields Others: Operating Without Load 1 Extend Out 2 Lower Boom and Hold @ 30 degrees 3 Raise Boom and Hold @ 45 degrees 4 Swing Left and Stop @ 90 degrees 5 Swing Right and Stop @ 180 degrees 6 Lower Load Block to Approx. 10` from Ground and Stop 7 Raise Load Block to Approx. 25" from Ground and Stop 8 Engage Power and Lower Block Approx. 5` and Stop 9 Check all Lock Mechanisms Operational Data 1 Weight used during test 2 Size of Weight 3 Weight in Tons 4 Boom Length 5 Working Radius 6 Boom Section 6.1 Section No. 1 6.2 Section No. 2 6.3 Section No. 3 Operational Load Testing 1 Position Crane (Boom Overside) 2 Lower Boom to Predetermined Load and Stop 3 Rig Load and Hoist Slowly Until Slacked is remove 4 Hosit Load 6` Off Ground and Stop. Check Stability 5 Hoist Load Approx. 4` from Ground and Stop 6 Check if Hoist does not self release 7 Check if Boom does not release 8 Swing Towards rear 90 degrees and Stop 9 Swing Back towards side 90 degrees and Stop 10 Lock all mechanisms and check for change Computer & Safety Devices 1 Alarms and signal functioning when of reaches safety limits 2 Radius indicator functioning 3 Over Hoisting device operational 4 Load moment indicator (LMI) set with SWL limit 5 By-pass switch functioning 6 Digital figures in the computer are clear Others 1 Operator Licensed 2 Riggers/Slingman qualified 3 Jib Boom property and safety connected 4 Leak on hose fittings of main boom

ASSESSMENT

REMARKS

page 2 of 3

Equipment Evaluation

Note: UTISI has Inspected and tested this equipment based on the Occupational Safety and Health Standards (As Amended), DOLE DAO #13: Guidelines Governing Occupational Safety and Health in the Construction Industry, ANSI and relevant engineering practices. UTISI denounce all liabilities and should not be legally accountable for any accident due to huaamn error, equipment component breakdown, equipment malfunction and / or any other failure succeding to this inspection.

TEST CONDUCTED BY:

ACKNOWLEDGED:

INSPECTOR

OPERATOR

WITNESSED BY:

CLIENT REPRESENTATIVE

page 3 of 3

SAFETY INSPETION ITEMS Electrical Accessories 1 Spot Lights 2 Horn 3 Windshield Wiper 4 Mirror / Windshields Others: Operating Without Load 1 Extend Out 2 Lower Boom and Hold @ 30 degrees 3 Raise Boom and Hold @ 45 degrees 4 Swing Left and Stop @ 90 degrees 5 Swing Right and Stop @ 180 degrees 6 Lower Load Block to Approx. 10` from Ground and Stop 7 Raise Load Block to Approx. 25" from Ground and Stop 8 Engage Power and Lower Block Approx. 5` and Stop 9 Check all Lock Mechanisms Operational Data 1 Weight used during test 2 Size of Weight 3 Weight in Tons 4 Boom Length 5 Working Radius 6 Boom Section 6.1 Section No. 1 6.2 Section No. 2 6.3 Section No. 3 Operational Load Testing 1 Position Crane (Boom Overside) 2 Lower Boom to Predetermined Load and Stop 3 Rig Load and Hoist Slowly Until Slacked is remove 4 Hosit Load 6` Off Ground and Stop. Check Stability 5 Hoist Load Approx. 4` from Ground and Stop 6 Check if Hoist does not self release 7 Check if Boom does not release 8 Swing Towards rear 90 degrees and Stop 9 Swing Back towards side 90 degrees and Stop 10 Lock all mechanisms and check for change Computer & Safety Devices 1 Alarms and signal functioning when of reaches safety limits 2 Radius indicator functioning 3 Over Hoisting device operational 4 Load moment indicator (LMI) set with SWL limit 5 By-pass switch functioning 6 Digital figures in the computer are clear Others 1 Operator Licensed 2 Riggers / Slingman qualified 3 Jib Boom property and safety connected 4 Leak on hose fittings of main boom

ASSESSMENT

REMARKS

page 2 of 3

Equipment Evaluation

Note: Leighton Contractor (Phil) Inc. has Inspected and tested this equipment based on the Occupational Safety and Health Standards (As Amended), DOLE DAO #13: Guidelines Governing Occupational Safety and Health in the Construction Industry, ANSI and relevant engineering practices. LCPI denounce all liabilities and should not be legally accountable for any accident due to huaamn error, equipment component breakdown, equipment malfunction and / or any other failure succeding to this inspection.

TEST CONDUCTED BY:

ACKNOWLEDGED:

INSPECTOR

OPERATOR

WITNESSED BY:

DOLE REPRESENTATIVE

CLIENT REPRESENTATIVE

page 3 of 3