Professional Documents
Culture Documents
Form-I-001
Capacity : Date :
Manufacturer :
Approved by :
Company User :
Certificate Number :
Reviewed by :
Month of Inspection :
This form must be completed by the crane operator and company user before entering the crane to be operated in the
site project area, and at any time of setting location. All crane condition must meet to the safety regulation and ADHI
SHE Management Plan
Result column: ( ) Yes/Good, Acceptable, ( X ) Not/Bad, Not to use, ( NA ) Not applicable
Wiring system
9 Safety Device
Anti-Two Block Devices
Boom Backstop Devices
Swing Radius Warning Devices
10 Boom Section
Main Boom, Jib Boom, Boom Extension
Boom Stop
Jib Boom Stops
Boom Angle Indicator
Boom Hoist Disconnect,
Automatic Boom Hoist Shut off
11 Leveling Indicating Device
12 Load Rating Chart
13 Sheaves
Ensure hoist line and sheave size match
Worn
Lubrication/Move freely
14 Main Hoist and Auxiliary Drums System
Proper Size and Spoiling of Hoist lines
Drum Sides/Shields for Cracks
Dogs/Pawls/Locking Devices
Drum Rotation vs. Control Motion
Clutch and Brakes
15 Load Hooks and Hook Blocks
Sheaves Function Smoothly
Hook Rotates Freely/Lubricated
Proper Becket
Properly Reeve
Safety latch
16 Hydraulic Hoses Fittings and Tubing
17 Outriggers
Lubrication
Structural Condition
Pressure hoses/connections
18 Wire Rope
Overall Condition
End Connections
Lubrication
Clips
19 Cab
Glass/Visibility
Instruments and Controls
Functioning Horn (warning signal)
INSPEKSI ALAT DAN PERALATAN
Fire Extinguisher
Appropriate Load Charts and Warning Signs
Proper and Adequate Access (steps/walkway)
20 Counterweight
Proper Size
Attachment Connection/Bolts
21 Load test
INSPECTOR REPORT
Corrective Action Required
Inspection Status: OK
Not OK