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TECHNICAL SERVICES

INSPECTION & CORROSION PROCEDURES FORM: MH-2


REV.: 0
MAN LIFT INSPECTION FORM
ELB: J.Y
Operations Integrity Management Systems
APROB: COX
(OIMS)
ORIGINAL ISSUE: 11/21/2014
Insp.
Contractor: Insp. Date: Location :
GENERAL EQUIPMENT

Manufacturer: Serial: Model:


Capacity: Work Hours:
Certified by: Expire day:
Inspector: Next Insp. Day:

SI NO
The above items shall be inspected in details as per
Inspection After Certification Code Reference: ASME B 30.23.

INSPECTION RESULTS
CONDITION
COMMENTS
DESCRIPTION SAT UNSAT
Safety Systems

Equiptment Certification is Update


Name Plate Legible
Safety and Governor System
Control Panel (MANLIFT)
Control Panel (BASKET)
Emergency terminal stopping and speed limiting devices
Leveling Zone and Speed indicator
Governors
Safe Alarm
Stand-by Power Operation
Fire extinguisher
Load Supporting Welds/Bolts
Load Supporting Members
Barrier From Toe Board To Intermediate Rail
Structure Basket
Fall Protection Device Anchorage Points
Gate Locking Mechanisms
Structure

Platform Flooring
Lifting Arm System
Suspension Attachments Poins
Stand-by Power Operation
Load test & drop test with load.
Structure Lifting Arm
Telescopic Arm System
Arm Rotation System
Pin/Ears/Bolt-Ups/Eyes (circle).
Systems Mecha
Attach

nisms
Hydraulic ment

Wire Rope/Chain/Rigid Leg (circle)


Master Link
Hoses and Conex. Hydraulics Systems.
Brake
Oil Buffers
Direction
System Inclination Basket
System Turn Basket
Overhead Protecction
Flotation
Operability

Platform Controls Special


List:

Tires
Load test & drop test with load.

Observed Conditions:
Results Of The Inspection

Corrective Actions:

Final Condition:
CONTRACTOR REVIEWED BY APPROVED
LINE APPROVAL

Empresa
Firma
Nombre
Fecha

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