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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6. Does the ratchet type travel brake hold satisfactorily? Yes____ No____
7. Are the travel base to axel bolts tight? Yes____ No____

Rotating Base

1. Are the rotating gears in good condition? Yes____ No____

2. Are traveling shaft spur pinion teeth in good condition? Yes____ No____
3. Is rotating brake in good condition? Yes____ No____
4. Is the slewing bearing in good condition? Yes____ No____
5. Are all guards installed on machine? Yes____ No____

Crawler Assembly

1. Are the drive sprockets in good condition? Yes____ No____

2. Are the crawler rollers in good condition? Yes____ No____
3. Are the bushings in good condition? Yes____ No____
4. Are the drive end take-up bolts in good condition? Yes____ No____
5. Is the crawler side frame in good condition? Yes____ No____
6. Are the crawler track link pins in good condition? Yes____ No____
7. Are drive chain and sprockets in good condition? Yes____ No____
8. Are the axels in good condition? Yes____ No____
9. Are the thread links in good condition? Yes____ No____
10. Are the threads properly adjusted? Yes____ No____
11. Are all frame and bearing bolts tight? Yes____ No____

Boom

1. Is the hoist rope in good condition? Yes____ No____

2. Is the pendant in good condition? Yes____ No____
3. Are the main chords of boom in good condition? Yes____ No____
4. Is the lacing of boom in good condition? Yes____ No____
5. Are point sheaves and bearings in good condition? Yes____ No____
6. Are cable guides on point? Yes____ No____
7. Are pins of proper size and all in place?
(Includes all excavation equipment and buckets) Yes____ No____
8. Are pins at connections locked in with cotter key? Yes____ No____
9. Are boom stops in good condition? Yes____ No____
10. Are boom foot bushings tight? Yes____ No____
11. In addition, a derrick shall be inspected for all of the following:
A. Structural members for deformation, cracks and corrosion? Yes____ No____
B. Bolts or rivets for tightness? Yes____ No____

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 C. All of the following for wear, cracks and distortion:
I. Pins? Yes____ No____
II. Bearings? Yes____ No____
III. Shafts? Yes____ No____
IV. Gears? Yes____ No____
V. Sheaves? Yes____ No____
VI. Drums? Yes____ No____
VII. Rollers? Yes____ No____
VIII. Locking and clamping devices? Yes____ No____
D. Gudgeon Pins? Yes____ No____
E. Derrick Hooks? Yes____No____

Machinery Cab

1. Is cab in good condition? Yes____ No____

2. Is glass in cab in good condition? Yes____ No____
3. Are operator controls in good condition? Yes____ No____
4. Is air or hydraulic systems deteriorated or leaking? Yes____ No____
5. Is there blistering or abnormal deformation to the outer covering
of the hydraulic or pneumatic hose? Yes____ No____
6. Is there evidence of leakage at the surface of flexible hose or
its junction with the couplings? Yes____ No____
7. Is there evidence of leakage at the threaded or clamped joints,
or excessive abrasion or scrubbing on the outer surface
of a hose, rigid tubing, or fitting? Yes____ No____
8. Is capacity chart in machine and visible? Yes____ No____
9. Is fire extinguisher in cab? Yes____ No____

General

1. Are crane tires in good condition? Yes____ No____

2. Are out-riggers and pads in good condition? Yes____ No____
3. Are the cables in good condition? Yes____ No____
4. Are cables dead-ended properly? Yes____ No____
5. Are the cable eyes in good condition? Yes____ No____
6. Is the cable sufficient in length? Yes____ No____
7. Is the rope reeving in compliance with manufacturers
recommendation? Yes____ No____
8. Are the crane hooks in good condition? Yes____ No____
9. Are all safety devices in place and operative? Yes____ No____
10. Are there significant inaccuracies in the load, boom angle,
and other indicators over the full range of the indicators? Yes____ No____
11. Has boom been damaged and repaired? Yes____ No____

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Describe repairs to boom and test procedures:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
12. Have all hydraulic and pneumatic pumps and motors been inspected and repaired for
the following:
I. Loose bolts and fasteners? Yes____ No____
II. Leaks at joints between connections? Yes____ No____
III. Shaft seal leaks? Yes____ No____
IV. Unusual noises or vibration? Yes____ No____
V. Loss of operating speed? Yes____ No____
VI. Excessive heating of the fluid? Yes____ No____
VII. Loss of pressure? Yes____ No____
13. Have all hydraulic and pneumatic valves been inspected and repaired for the
following:
I. Cracks in the valve housing? Yes____ No____
II. Improper return of the spool to the neutral position? Yes____ No____
III. Leaks at spools or joints? Yes____ No____
IV. Sticking spools? Yes____ No____
V. Proper relief valve pressures as specified by the
manufacturer? Yes____ No____
14. Have all hydraulic and pneumatic cylinders been inspected and repaired for the
following:
I. Drifting caused by fluid leaking past the piston? Yes____ No____
II. Rod seals leaking? Yes____ No____
III. Leaks at welded joints? Yes____ No____
IV. Scored, nicked or dented piston rods? Yes____ No____
V. Dented case (barrel)? Yes____ No____
VI. Loose or deformed rod end or connecting joint? Yes____ No____
VII. Evidence of rubber particles or metal chips on filter the
elements of hydraulic filters? Yes____ No____
15. Have additions or alterations been made to counterweight? Yes____ No____
Describe:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

16. Have all defects been repaired or replaced? Yes____ No____

17. Do all replacement parts have at least the original safety factor? Yes____ No____
18. Was the annual inspection performed, by a qualified person,
in compliance with the applicable ANSI standards and
manufacturers specifications? Yes____ No____

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19. 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 list may not be complete for ________________________
all types and models of equipment. The Name
manufacturers inspection
recommendations and applicable ANSI
________________________
standards must be consulted and followed. Signature