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Annual Inspection Report

Owner: _________________________________________ Date: ___________________

Make: _____________________________ Model: ________ S/N: _______ Year: _____

Engine

1. Does the engine start and run smoothly? Yes____ No____
2. Is oil pressure adequate? Yes____ No____
3. Is fuel pressure adequate? Yes____ No____
4. Are fan belts properly adjusted? Yes____ No____
5. Is the radiator core clean? Yes____ No____
6. Is there evidence of oil leaks? Yes____ No____
7. Is engine clutch properly adjusted? Yes____ No____

Drum Shaft Assembly

1. Is there excessive wear on brake and clutch system parts, linings,
pawls, and ratchets? Yes____ No____
2. Are friction flanges scored? Yes____ No____
3. Are drum clutches holding properly? Yes____ No____
4. Are drum sleeve bearings properly adjusted? Yes____ No____
5. Are drum brakes holding properly? Yes____ No____
6. Are all clutch control parts properly lubricated? Yes____ No____

Independent Boom Hoist

1. Are brake linings in good condition? Yes____ No____
2. Is boom hoist operating satisfactorily? Yes____ No____
3. Does friction brake operate satisfactorily? Yes____ No____
4. Does ratchet brake operate satisfactorily? Yes____ No____
5. Is hoist rope properly wound on drum? Yes____ No____

Travel Base

1. Are the teeth of ring gear in good condition? Yes____ No____
2. Is the roller path on ring gear in good condition? Yes____ No____
3. Are the travel gears inside the travel base in good condition? Yes____ No____
4. Does the machine steer properly? Yes____ No____
5. Does the band type travel brake hold satisfactorily? Yes____ No____

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Are all guards installed on machine? Yes____ No____ Crawler Assembly 1. Are point sheaves and bearings in good condition? Yes____ No____ 6. a derrick shall be inspected for all of the following: A. Are pins at connections locked in with cotter key? Yes____ No____ 9. Does the ratchet type travel brake hold satisfactorily? Yes____ No____ 7. Is the pendant in good condition? Yes____ No____ 3. Is the slewing bearing in good condition? Yes____ No____ 5. Are the bushings in good condition? Yes____ No____ 4. Are the thread links in good condition? Yes____ No____ 10. Structural members for deformation. In addition. Is rotating brake in good condition? Yes____ No____ 4. Are boom stops in good condition? Yes____ No____ 10. Is the crawler side frame in good condition? Yes____ No____ 6.6. cracks and corrosion? Yes____ No____ B. Are the crawler track link pins in good condition? Yes____ No____ 7. Bolts or rivets for tightness? Yes____ No____ 2 . Is the hoist rope in good condition? Yes____ No____ 2. Are the axels in good condition? Yes____ No____ 9. Are the crawler rollers in good condition? Yes____ No____ 3. Are pins of proper size and all in place? (Includes all excavation equipment and buckets) Yes____ No____ 8. Are all frame and bearing bolts tight? Yes____ No____ Boom 1. Are traveling shaft spur pinion teeth in good condition? Yes____ No____ 3. Are the rotating gears in good condition? Yes____ No____ 2. Are drive chain and sprockets in good condition? Yes____ No____ 8. Are the main chords of boom in good condition? Yes____ No____ 4. Are boom foot bushings tight? Yes____ No____ 11. Is the lacing of boom in good condition? Yes____ No____ 5. Are the drive sprockets in good condition? Yes____ No____ 2. Are the threads properly adjusted? Yes____ No____ 11. Are the travel base to axel bolts tight? Yes____ No____ Rotating Base 1. Are cable guides on point? Yes____ No____ 7. Are the drive end take-up bolts in good condition? Yes____ No____ 5.

or fitting? Yes____ No____ 8. Is there evidence of leakage at the surface of flexible hose or its junction with the couplings? Yes____ No____ 7. Has boom been damaged and repaired? Yes____ No____ 3 . Is cab in good condition? Yes____ No____ 2. Bearings? Yes____ No____ III. Gudgeon Pins? Yes____ No____ E. Locking and clamping devices? Yes____ No____ D. Is the cable sufficient in length? Yes____ No____ 7. Are out-riggers and pads in good condition? Yes____ No____ 3. boom angle. Is capacity chart in machine and visible? Yes____ No____ 9. Are the crane hooks in good condition? Yes____ No____ 9. Gears? Yes____ No____ V. Drums? Yes____ No____ VII. and other indicators over the full range of the indicators? Yes____ No____ 11. Derrick Hooks? Yes____No____ Machinery Cab 1. All of the following for wear. Are the cables in good condition? Yes____ No____ 4. C. Are crane tires in good condition? Yes____ No____ 2. Sheaves? Yes____ No____ VI. Shafts? Yes____ No____ IV. Are operator controls in good condition? Yes____ No____ 4. Is there evidence of leakage at the threaded or clamped joints. Pins? Yes____ No____ II. rigid tubing. Is air or hydraulic systems deteriorated or leaking? Yes____ No____ 5. Is fire extinguisher in cab? Yes____ No____ General 1. Are the cable eyes in good condition? Yes____ No____ 6. Are cables dead-ended properly? Yes____ No____ 5. Rollers? Yes____ No____ VIII. Is there blistering or abnormal deformation to the outer covering of the hydraulic or pneumatic hose? Yes____ No____ 6. Are there significant inaccuracies in the load. Is the rope reeving in compliance with manufacturers recommendation? Yes____ No____ 8. Are all safety devices in place and operative? Yes____ No____ 10. or excessive abrasion or scrubbing on the outer surface of a hose. Is glass in cab in good condition? Yes____ No____ 3. cracks and distortion: I.

Excessive heating of the fluid? Yes____ No____ VII. Proper relief valve pressures as specified by the manufacturer? Yes____ No____ 14. by a qualified person. Have all hydraulic and pneumatic cylinders been inspected and repaired for the following: I. Evidence of rubber particles or metal chips on filter the elements of hydraulic filters? Yes____ No____ 15. Unusual noises or vibration? Yes____ No____ V. Shaft seal leaks? Yes____ No____ IV. Cracks in the valve housing? Yes____ No____ II. Sticking spools? Yes____ No____ V.Describe repairs to boom and test procedures: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 12. Rod seals leaking? Yes____ No____ III. Have all defects been repaired or replaced? Yes____ No____ 17. Have additions or alterations been made to counterweight? Yes____ No____ Describe: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 16. in compliance with the applicable ANSI standards and manufacturer’s specifications? Yes____ No____ 4 . Loss of pressure? Yes____ No____ 13. Loose or deformed rod end or connecting joint? Yes____ No____ VII. Scored. Loss of operating speed? Yes____ No____ VI. Loose bolts and fasteners? Yes____ No____ II. Drifting caused by fluid leaking past the piston? Yes____ No____ II. nicked or dented piston rods? Yes____ No____ V. Do all replacement parts have at least the original safety factor? Yes____ No____ 18. Dented case (barrel)? Yes____ No____ VI. Leaks at spools or joints? Yes____ No____ IV. Leaks at joints between connections? Yes____ No____ III. Was the annual inspection performed. Have all hydraulic and pneumatic valves been inspected and repaired for the following: I. Have all hydraulic and pneumatic pumps and motors been inspected and repaired for the following: I. Improper return of the spool to the neutral position? Yes____ No____ III. Leaks at welded joints? Yes____ No____ IV.

The list may not be complete for ________________________ all types and models of equipment.19. Signature 5 . Is a copy of the inspection maintained on the jobsite for each piece of equipment and readily available? Yes____ No____ Inspection conducted by: This annual inspection report is intended to be an all-purpose crane inspection guideline. The Name manufacturer’s inspection recommendations and applicable ANSI ________________________ standards must be consulted and followed.