Professional Documents
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FOR
LIFTING EQUIPMENT
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND
A FIRE DEPARTMEN
D NT
INSPE
ECTION CHE
ECK LIST FO
OR MOBILE C
CRANE (PRE
E ENTRY & P
PERIODIC)
Issue No.: 01
0 Re
ev. No: 00 Date: 01-01-201
14 Fo
orm No – LM
M02
IN
NSPECTION CHEC
CK LIST FOR MO
OBILE CR
RANE (PR
RE ENTR
RY & PER
RIODIC)
Pla
ant / Agency
y Equipmen
nt Number
De
epartment - S
Section Identifica
ation Markin
ng
HO
OD (Name) T.P. Certificate No
Location of Ins
spection Date of T.P.
T Inspectio
on
Ins
spection Fre
equency S.W.L. (M
Marked)
C
CHECK ITEM
MS
Dates of In
nspection
Srr.
DESCRIP
PTION
Noo
Is Wire ro
ope free from
m tolerable Da
amage?
4
(Kinked, W
Wear, Brokenn wire more th
han 10% etc.))
Is Load - Wire rop pe & other parts are well
5
Lubricateed?
Any Oil Leakage from Hydraulic pa arts (Piston
6
drums)?
7 Is any Da
amage in Tires (Crack, Cut, air pressure etc.)
8 Are Head
d Lights & Rea
ar Lights in good
g conditio
on?
9 Is Front H
Horn in workiing Condition
n?
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR GANTRY CRANE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM03
CHECK ITEMS
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR ELECTRICALLY OPERATED HOIST
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM04
CHECK ITEMS
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR CHAIN PULLEY BLOCK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM05
CHECK ITEMS
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR PULL LIFT
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM06
CHECK ITEMS
5 Is it properly lubricated?
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR WINCH MACHINE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM07
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
CHECK ITEMS
Remarks:
SN Observations
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE – HOOK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM08
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
1 Is SWL marked?
Is there any Physical Damage in Hook?
2
(Wear / Crack / Corrosion Reduction more than 10%)
Is there any Physical Deformation in Hook?
3
(Elongation / Spread / Twist more than 10 degree)
Is Hook safety latch with the spring provided /
4
properly positioned?
Is Throat Opening not more than 15% or 1/5th
5
of the original dimension of the Hook?
Is there any Jam in Hook movement? –
6
(Swivel Hook rotates freely).
7 Is Colour coding for the current year painted?
8 Is Third Party (TP) Test certificate available?
9 Any Other
Remarks:
SN Observations
1
2
3
4
5
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE – HOOK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM08
Deformation Any bending or twisting exceeding 10 degrees from the plane of the unbent hook, unless
otherwise directed by the hook manufacturer
Throat Opening Any distortion causing an increase in throat opening exceeding 15 % or as otherwise
directed by the hook manufacturer
Wear Any wear exceeding 10 % of the original section dimension of the hook or its load pin or
as otherwise directed by the hook manufacturer
Cracks Any visible crack (in case of any doubt replace it or check with DP test / NDT test)
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE - SHACKLE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM09
INSPECTION CHECK LIST FOR LIFTING TACKLE – SHACKL (BOW & DEE)
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
1 Is SWL marked?
Is there any Physical Damage in Shackle?
2
(Wear / Crack / Corrosion Reduction more than 10%)
Is there any Physical Deformation of Shackle?
3
(Elongation / Spread / Twist)
Is Safety Screw Lock pin straight?
4
(Wear more than 10 %.)
Is Safety Screw Lock pin seated properly in
5
positioned?
6 Is Shackle Throat not Opening up?
7 Is Colour coding for the current year painted?
8 Is Third Party (TP) Test certificate available?
9 Any Other
Remarks:
SN Observations
1
2
3
4
5
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE - SHACKLE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM09
Deformation Any bending or twisting from the plane of the unbent shackle, unless otherwise
directed by the shackle manufacturer
Throat Opening Any distortion causing an increase in (pin throat width) opening exceeding 15 % or as
otherwise directed by the shackle manufacturer
Pin Sealing All pins must be straight and all screw pins must be completely seated. Cotter pins must
be used with all round pin shackles
Wear Any wear exceeding 10 % of the original dimension of crown or the pin of the shackles
or as otherwise directed by the shackle manufacturer
Cracks Any visible crack (in case of any doubt replace or check with DP test / NDT test)
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE - WIRE ROPE SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM10
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
1 Is SWL marked on Wire rope Sling?
2 Is Physical Damage - Broken wires in Wire rope?
Is Physical Damage - Crack / Worn / Corrosion in
3
Wire rope? (Reduction more than 10%)
Is Physical Deformation in Wire rope Sling?
4
(Stretch / Bird cage / Kink )
5 Is Colour coding for the current year painted?
6 Is Third Party (TP) Test certificate available?
7 Any Other
Remarks:
SN Observations
1
2
3
4
5
Name
Checked by
Signature
SAFETY AND
A FIRE DEPARTMEN
D NT
IN
NSPECTION CHECK LIST
T FOR WIRE
E ROPE
Issue No.: 01
0 Re
ev. No: 00 Date: 01-01-201
14 Fo
orm No – LM
M10
WIRE
W ROP
PE INSPEC
CTION (CO
OMMON DEFECTS
D O WIRE R
OF ROPES)
The
T defects to
o be looked du uring inspectio
ons are crushed flattened orr jammed stran
nds, bird cagin
ng, kinks, high stranding andd un-
la
aying, bulges in the rope, co
ore protrusion, heat damage, damaged or inadequate splices etc. Permmanent damage e and deteriora
ation
such
s as kinkedd, crushed, flattened or disttorted strandss and unbalanc ations are the conditions, which
ced wear loca w make a rope
susceptible
s to ffailure.
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
1 Is SWL marked on Chain Sling?
Is any Physical Damage – Extremely Worn at
2
Chain link bearing surface? (more than 10%)
3 Is any Physical Damage - Crack in Chain Link?
Is any Physical Damage Corrosion in Chain
4
Link? (Reduction more than 10%)
Is any Physical Damage Stretch / Elongation in
5
Chain Link?
Is any Physical Damage Twist / Bent in Chain
6
Link?
7 Is Colour coding for the current year painted?
8 Is Third Party (TP) Test certificate available?
9 Any Other
Remarks:
SN Observations
1
2
3
4
5
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE - STRAP / WEB SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM12
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
7 Any Other
Remarks:
SN Observations
1
2
3
4
5
Name
Checked by
Signature
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR LIFTING TACKLE – ATTACHMENT
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM13
CHECK ITEMS
Sr. Dates of Inspection
DESCRIPTION
No
Is SWL marked on Attachment?
1
(Wire Rope Clamp, Wedge socket, Eye Bolt, etc.)
Is any Physical Damage – Extremely Worn at
2
bearing surface? (more than 10%)
Is any Physical Damage - Crack in Attachment?
3
(Wire Rope Clamp, Wedge socket, Eye Bolt, etc.)
Is any Physical Damage Corrosion in
4
Attachment? Reduction more than 10%
Is any Physical Damage Stretch / Elongation in
5
Attachment?
Is any Physical Damage Twist/Bent in
6 Attachment?
(Wire Rope Clamp, Wedge socket, Eye Bolt, etc.)
7 Is Colour coding for the current year painted?
9 Any Other
Remarks:
SN Observations
1
2
3
4
5
Name
Checked by
Signature
SAFETY AND
A FIRE DEPARTMEN
D NT
INSP
PECTION CH
HECK LIST FOR SHEAVE
E PULLEY
Issue No.: 01
0 Re
ev. No: 00 Date: 01-01-201
14 Fo
orm No – LM
M14
IN
NSPECTION CHEC
CK LIST FOR SHE
EAVE PU
ULLEY
Check Sheavve
groove for
Check Flan
nge
Check groov ve for wear
for correct ssize
Pla
ant / Agency
y Equipment Number
De
epartment - S
Section Identificatiion Marking
HO
OD (Name) T.P. Certificate No
Location of Ins
spection Date of T.P
P. Inspection
Ins
spection Fre
equency S.W.L. (Marrked)
C
CHECK ITEM
MS
Srr. D
Dates of Ins
spection
DESCRIP
PTION
Noo
1 Is SWL mmarked on She eave Pulley?
Is any Phhysical Damag ge in Wear in Sheave
2
Pulley Grroove?
Is any Phhysical Damag ge - Crack in Sheave Pulley
3
flange / R
Rim?
Is any Phhysical Damag ge in Sheave Pulley
4
Bearing?
Is Physical Damage Tw wist / Bent in
n Sheave
5
Pulley?
6 Is Pulley used for corrrect size of Wire
W rope?
7 Is Sheave
e Pulley Lubriicated Properly?
8 Are all th
he Pulley rotates freely?
9 Is Colour coding for th
he current ye
ear painted?
10
0 Is Third Party
P (TP) Tesst certificate available?
11 Any Othe
er
Rem
marks:
SN
N Observations
1
2
3
4
5
Name
Ch
hecked by
Signature
e
SAFETY AND FIRE DEPARTMENT
INSPECTION CHECK LIST FOR SHEAVE PULLEY
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM14
Check Sheave
groove for wear
Check Flange
for wear
o Replace Pulley block if sheave having deeply worn or scored groove, a cracked or broken rim and worn or
damaged bearings.
o Proper pulley should be used according to the requirement of work.
o In no case pulley meant for Fibre rope should be used with steel wire rope
o Grooves of the sheaves should be uniform and smooth. The rope should run free without touching
against the block or suspension parts
o Sheaves of pulley should rotate freely on the shaft.
o The shaft should be free from crack and should not be worn out.
o Rope pulley Sheaves, shaft, hook, hook pin, locking of pins should be checked. Before use and lubricate
all parts where necessary
o Anti-twister should be used to prevent rubbing of ropes against, one another.
o Anchorage of pulley should be strong and firm.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR HYDRA
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS01
HYDRA
SN Deficiency List
Annual Examination
Sr. HYDRA Type / Deficiency
Location Corrective Action Taken
No. No. Capacity Last Due No.
Date Date
1
5
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR HYDRA
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS01
Annual Examination
Sr. HYDRA Type / Deficiency
Location Corrective Action Taken
No. No. Capacity Last Due No.
Date Date
6
10
11
12
13
14
15
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: One copy of Form No. 09 for annual examination / testing to be kept with concerned Department.
SAFETY AND
A FIRE DEPARTMEN
D NT
SURVEY CH
HECK SHEE
ET FOR MOB
BILE CRANE
E (TELESCOP
PIC)
Issue No.: 01
0 Re
ev. No: 00 Date:: 01-01-2014 Fo
orm No – LS
S02
SU
URVEY C
CHECK SHEET
S FO
OR MOBILE CRAN
NE (TELE
ESCOPIC
C)
Pla
ant Ins
spection Fre
equency M
Monthly
Area / Departm
ment Da
ate
MO
OBILE CRAN
NE (TELESC
COPIC)
SN D
Deficiency L
List
1 S
SWL NOT Marrked on Crane
e & Anchoring Hooks
2 S
Safety Latch iin Hook is NO
OT provided / Hook Damag
ged
3 H
Hoist limit switch and Platte NOT provid
ded
Wire rope is NOT
W N free from
m tolerable Da
amage
4
(K
Kinked, Wearr, Broken wire
e more than 10% etc.)
5 L
Load - Wire ro
ope & other parts are NOT well Lubricated
6 O Leakage frrom Hydraulic
Oil c parts (Pisto
on drums).
7 D
Damaged Tire
es (Crack, Cutt, air pressure
e etc.)
8 H
Head Lights & Rear Lights are NOT in g
good conditio
on
9 F
Front Horn is NOT working
g
10 R
Reverse Horn NOT provide
ed / NOT in go
ood condition
n
Boom structu
B ure NOT in good cond dition while full
11
e
expansion (Da
amage, Crack
k or Jam while
e extending).
12 B
Brakes are NO
OT in good co
ondition?
Travelling, Steering,
T S Braking mottions (in both
13
d
directions) are
e NOT satisfaactory
L
Load Chart NO OT Displayed in Operator Cabin
14
L
Load at the apppropriate radius.(Max & Min
M radii)
15 O
Operating Instruction and Warning Sign
ns NOT Displayed
16 F Extinguissher is NOT prrovided in Op
Fire perator Cabin
n
Operator is NO
O OT having Va
alid Driving License
17
(H
Heavy duty)
C
Crane is NOT
T having Valid RTO Fitne ess / Third Party
P
18
fiitness
19 O
Outriggers / Stability
S of Crane is NOT sa
atisfied
20 C
Crane is NOT SUITABLE for Use at site
21 A Other
Any
T.P. Examina
ation
Srr. CRAN
NE Type / Defficiency
Loca
ation Corrective Action Tak
ken
No
o. No. Capacity Last
L Due
D No.
Date
D D
Date
1
5
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR MOBILE CRANE (TELESCOPIC)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS02
T.P. Examination
Sr. CRANE Type / Deficiency
Location Corrective Action Taken
No. No. Capacity Last Due No.
Date Date
6
10
11
12
13
14
15
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND
A FIRE DEPARTMEN
D NT
SURVEY CHECK
C SHE
EET FOR MO
OBILE CRANE (CROWLE
ER)
Issue No.: 01
0 Re
ev. No: 00 Date:: 01-01-2014 Fo
orm No – LS
S03
SU
URVEY C
CHECK SHEET
S FO
OR MOBILE CRAN
NE (CRO
OWLER)
Pla
ant Ins
spection Fre
equency M
Monthly
Area / Departm
ment Da
ate
MO
OBILE CRAN
NE(CROWLE
ER)
SN De
eficiency Lis
st
1 SW
WL NOT Mark
ked on Crane & Anchoring Hooks
2 Safety Latch in
n Hook is NOT
T provided / H
Hook Damage
ed
3 Ho
oist limit swittch and Plate NOT provide
ed
Wiire rope is NO
OT free from ttolerable Dam
mage
4
(Kiinked, Wear, Broken wire m
more than 10 0% etc.)
5 Load - Wire rop
pe & other parts are NOT well
w Lubricate
ed
6 Oill Leakage from Hydraulic parts (Piston
n drums).
7 Da
amaged Tires (Crack, Cut, air pressure etc.)
e
8 He
ead Lights & R
Rear Lights are
a NOT in go
ood condition
n
9 Fro
ont Horn is NOT
N working
10 Re
everse Horn NOT
N provided
d / NOT in goo
od condition
Bo
oom structure NOT in good cond dition while full
11
expansion (Dam
mage, Crack or
o Jam while extending).
12 Bra
akes are NOT
T in good con
ndition?
Tra
avelling, Stee
ering, Braking
g motions (in
n both directions)
13
are
e NOT satisfaactory
Load Chart NOT T Displayed in Operator Cabin
14
Load at the apppropriate radius.(Max & Min
M radii)
15 Op
perating Instrruction and Warning
W Signss NOT Display
yed
16 Firre Extinguisher is NOT pro
ovided in Ope
erator Cabin
Opperator is NOT
T having Valid Driving License
17
(Heavy duty)
Craane is NOT having Valid d RTO Fitne ess / Third Party
P
18
fitness
19 Sta
ability of Crane is NOT satisfied
20 Cra
ane is NOT SUITABLE for Use at site
21 An
ny Other
T.P. Examina
ation
Srr. CRAN
NE Type / Defficiency
Loca
ation Corrective Action Tak
ken
No
o. No. Capacity Last
L Due
D No.
Date
D D
Date
1
5
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR MOBILE CRANE (CROWLER)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS03
T.P. Examination
Sr. CRANE Type / Deficiency
Location Corrective Action Taken
No. No. Capacity Last Due No.
Date Date
6
10
11
12
13
14
15
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR GANTRY CRANE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS04
GANTRY CRANE
SN Deficiency List
18 Any Other
T.P. Examination
Sr. CRANE Type / Deficiency
Location Corrective Action Taken
No. No. Capacity Last Due No.
Date Date
1
5
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR MOBILE CRANE (CROWLER)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS04
T.P. Examination
Sr. CRANE Type / Deficiency
Location Corrective Action Taken
No. No. Capacity Last Due No.
Date Date
6
10
11
12
13
14
15
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR ELECTRICALLY OPERATED HOIST
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS05
SN Deficiency List
1 EOT / HOIST is NOT Identified & Numbered
2 SWL NOT Marked on Hoist & Hooks
3 Safety Latch in Hook is NOT provided / Hook Damaged
Wire rope is NOT free from tolerable Damage
4
(Kinked, Wear, Broken wire more than 10% etc.).
5 Load - Wire rope & other parts are NOT well Lubricated
6 Hoist limit switch and Plate NOT provided / working
7 Long travel & Cross travel is NOT proper
8 Damaged Rail Poles / Wheels - Crack, etc.(If provided)
9 No / Damaged End Stoppers.
10 Electrical ON / OFF Isolation panel is NOT proper.
11 Emergency STOP Push Button is NOT functioning.
12 Defaced (Operation) Making NOT on control panel
13 Control functions are NOT functioning.
14 Hoist Operation - Unusual Noise & Jerky Motion.
15 Approach to Operator Cabin is not proper (If cabin)
16 Operating Instruction and Warning Signs NOT Displayed
17 Fire Extinguisher is NOT provided in Operator Cabin
18 Load lifting work place is NOT free from obstruction.
19 Load and Hook is left suspended.
20 EOT / HOIST is NOT having Valid Third Party fitness
21 Stability of Gantry Crane is NOT satisfied
22 EOT / HOIST is NOT SUITABLE for Use at site
23 Any Other
Annual Examination
Sr. HOIST Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
1
7
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR ELECTRICALLY OPERATED HOIST
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS05
Annual Examination
Sr. HOIST, Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
8
10
11
12
13
14
15
16
17
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR ELECTRICALLY OPERATED (WINCH)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LM06
SN Deficiency List
1 Winch is NOT Identified & Numbered
2 SWL NOT Marked on Winch & Hook
3 Hook Damaged / without Safety Latch
4 Damaged Wire rope -Kinked, Wear, Broken wire etc.
5 Wire rope & other parts are NOT Lubricated
5 turns of Wire rope NOT remain on drum when Hook is
6
in contact with the ground
Wire rope installed for winch is NOT on safe route and
7
with obstruction or rubbing
8 Sheaves Pulleys is NOT in good condition
9 Safety guards are NOT installed properly
10 Operating lever is NOT return to Neutral when released
11 Hoist limit switch (Over travel trip) NOT provided
12 Mechanical Breaks are NOT adequately rated for SWL
Electrical Breaks are NOT adequately rated for SWL &
13
Brakes auto apply on loss of power NOT working
14 Power cable used is NOT of correct type & size for Winch
Power cable is NOT properly terminated and Winch is
15
NOT effectively earthed?
Electrical Isolation panel is NOT proper / ELCB is NOT
16
provided for Emergency trip
Operating Instruction and Warning Signs NOT Displayed -
17
to check fail safe brake application before use
18 Defaced (Operation) Making NOT on control panel
19 Hoist Operation - Unusual Noise & Jerky Motion.
20 Winch operator is NOT qualified
21 Operator setting / Cabin is not proper (If cabin)
21 SIGNALLING - Operating levers NOT clearly labelled
22 Effective communication system is NOT established
23 Any Other
Annual Examination
Sr. WINCH Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
1
5
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR ELECTRICALLY OPERATED (EOT, HOIST)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS06
Annual Examination
Sr. WINCH Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
6
10
11
12
13
15
15
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TOOL CHAIN PULLEY BLOCK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS07
SURVEY CHECK SHEET FOR LIFTING TOOL - CHAIN PULLEY BLOCK (CPB)
SN Deficiency List
T.P. Examination
Sr. CPB Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
1
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TOOL - CHAIN PULLEY BLOCK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS07
T.P. Examination
Sr. CPB Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
16
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TOOL - PULL LIFT
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS08
SN Deficiency List
T.P. Examination
Sr. PULL LIFT Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
1
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TOOL - PULL LIFT
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS08
T.P. Examination
Sr. PULL LIFT Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
16
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE - HOOK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS09
SN Deficiency List
9 Any Other
T.P. Examination
Sr. Hook Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
1
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – HOOK
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS09
T.P. Examination
Sr. Hook Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
16
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE - SHACKLE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS10
SN Deficiency List
9 Any Other
T.P. Examination
Sr. Shackle Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
1
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – SHACKLE
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS10
T.P. Examination
Sr. Shackle Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
16
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – WIRE ROPE / WIRE ROPE SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS11
SURVEY CHECK SHEET FOR LIFTING TACKLE – WIRE ROPE / WIRE ROPE SLING
SN Deficiency List
9 Any Other
Details of Lifting Tackle - Wire rope/ Wire rope sling with Deficiency
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – WIRE ROPE / WIRE ROPE SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS11
Details of Lifting Tackle – Wire rope / Wire rope sling with Deficiency
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – CHAIN SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS12
SN Deficiency List
9 Any Other
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – CHAIN SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS12
T.P. Examination
Sr. Chain Sling Type / Deficiency
Location Corrective Action Taken
No. Sr. No. Capacity Last Due No.
Date Date
16
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – STRAP / WEB SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS13
SN Deficiency List
7 Any Other
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – STRAP / WEB SLING
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS13
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLES (ATTACHMENTS)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS14
LIFTING TACKLES (Attachment - Wire Rope Clamp, Wedge socket, Eye Bolts, etc.)
SN Deficiency List
SWL NOT marked on Attachment
1
(Wire Rope Clamp, Wedge socket, Eye Bolt, etc.)
Physical Damage – Extremely Worn at bearing surface –
2
(more than 10%)
Physical Damage - Crack in Attachment
3
(Wire Rope Clamp, Wedge socket, Eye Bolt, etc.)
Physical Damage Corrosion in Attachment.-
4
(Reduction more than 10%)
5 Physical Damage Stretch / Elongation in Attachment
Physical Damage Twist / Bent in Attachment
6
(Wire Rope Clamp, Wedge socket, Eye Bolt, etc.)
7 Colour coding for the current year not painted.
8 Third Party (TP) Test certificate not available
9 Any Other
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLES (ATTACHMENT)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS14
17
18
19
20
21
22
23
24
25
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE- SHEAVE PULLEY
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS15
SN Deficiency List
11 Any Other
10
SAFETY AND FIRE DEPARTMENT
SURVEY CHECK SHEET FOR LIFTING TACKLE – SHEAVE PULLEY
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No – LS15
12
13
14
15
16
17
18
19
20
Remarks:
SN Observations
10
Check By Review By
Signature
Name
Designation
Date
Note: Copy of Third Part periodic examination / test under Factories Act (Form) to be kept with concerned Department.
SAFETY AND FIRE DEPARTMENT
REGISTER – LIST OF LIFTING TACKLES & LIFTING MACHINE (GFR - Form No -10)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No - LR01
REGISTER – LIST OF LIFTING TACKLES & LIFTING MACHINE (GFR - Form No -10)
Plant
10
11
12
13
14
15
SAFETY AND FIRE DEPARTMENT
REGISTER – LIST OF LIFT & HOIST (GFR - Form No -09)
Issue No.: 01 Rev. No: 00 Date: 01-01-2014 Form No - LR02
10
11
12
13
14
15