CERTIFICATE FOR EXAMINATION OF OVERHEAD CRANE

Certificate No.:

Job No.:

NAME & ADDRESS OF OWNER:

TEST
LOCATION

DATE OF TEST

REGULATION
REFERENCE
BS7121 PART 2-7:
2012
EXPIRY DATE

SURVEY
REQUESTED BY

PREVIOUS
TEST DATE

Validation

PREVIOUS TEST
COMPANY

TEST EQUIPMENT REF.

EQUIPMENT DESCRIPTION:
MANUFACTURER/SUPPLIER:
MAKER SERIAL NO.:

TYPE OF TEST:
PLANT
NO:

MODEL/TYPE:

CHAIN:

LENGTH OF SPAN:
LENGTH OF TRAVEL:
HEIGHT :

ACTUAL DEFLECTION:

MAXIMUMALLOWABLE DEFLECTION:

SAFE WORKING LOAD:

PROOF LOAD APPLIED:

LAST NDT DATE:

NEXT NDT DATE:

REMARKS

We hereby certify that the above particulars are correct at that time of inspection/ test (see date of issue, below). Daily inspection & operational maintenance are
the sole responsibility of the user(s).
The validity of this report is12 months & may consider void in case of any modification or repairs have taken place, including any overloading or other misuse.

INSPECTOR
DOC. NO.: TM-03/QF-02
SIGNATURE

TECHNICAL
MANAGER
REV. NO.: 02 SIGNATURE
ISSUE DATE: 01.02.2015

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Job

Item Description

Remarks

ELECTRICAL

-Power Supply
-Electrical Panel
-Motors
Long Travel
-Main Support Structure
-Load Test
-Bolts& Connections
-Travel Wheels & Bearing
-Running Rail Condition
-End Carriage Buffer
-Long Travel Brake
HOIST UNIT

-Cross Travel Wheel

- Cross Travel Brake
- Cross Travel Buffer
-Roller
-Hoist Wire Rope/Rope Guide
-Hoist Rope Termination
-Hoist Block & Sheave
-Hoist Brake
-Safety Latch
LIMIT SWITCH

-Hoist Up/Down
-Long Travel
-Cross Travel
-Overload Cut-Off
-Anti Collision
PENDANT CONTROL

-Emergency Stop
-Button
-General Condition
-Safety of The Site

*This Certificate becomes invalid, if any substantial Alteration/Repair or Modification is made.

This is to certify that the undersigned, a competent representative, did attend to examine this equipment to as certain its safe
working condition and that the examination indicated that the said equipment has no indigenous injury or sighted deformation and
the safe working condition of the said equipment as either identified or tested is shown. The equipment is safe for its intended use
within the limits specified and at the time of inspection was found to be satisfactory for further use, provided there is continuous
maintenance applied and qualified operators employed.

Recommendations:

DOC. NO.: TM-03/QF-02

REV. NO.: 02

ISSUE DATE: 01.02.2015