REPORT OF THOROUGH EXAMINATION OF LIFTING EQUIPMENT

IN ACCORDANCE WITH LIFTING OPERATIONS & LIFTING EQUIPMENT REGULATIONS (LOLER) 1998
ONLY TO BE USED BY A COMPETENT PERSON *

NAME AND ADDRESS OF EMPLOYER (USER) FOR WHOM THIS EXAMINATION HAS BEEN MADE: RECORD NUMBER:

EXAMINATION DATE:

REPORT DATE:

LOCATION OR ADDRESS OF EXAMINATION (IF DIFFERENT): REASON FOR THOROUGH EXAMINATION TICK BOX
AFTER INSTALLATION OR ASSEMBLY -

IN SERVICE (WITHIN AN INTERVAL OF 6 MONTHS) -

IN ACCORDANCE WITH AN EXAMINATION SCHEME -

FOLLOWING EXCEPTIONAL CIRCUMSTANCES (E.G. ACCiDENT) -

DETAILS OF MACHINE
MAKE: MODEL: SERIAL NUMBER: DATE OF MANUFACTURE: HOURS:

DESCRIPTION: ATTACHMENTS:

RATED LOAD (KG): RATED LOAD (PERSONS + RATED SLOPE: MAX MANUAL FORCE: MAX WIND SPEED:
TOOLS):

DEFECTS
IDENTIFICATION OF ANY PART FOUND TO HAVE A DEFECT WHICH IS OR COULD BECOME A DANGER TO PERSONS AND A DESCRIPTION OF THE DEFECT AND
PARTICULARS OF ANY REPAIR, RENEWAL OR ALTERATION REQUIRED TO REMEDY A DEFECT FOUND TO BE A DANGER TO PERSONS. (ACTION TO TAKE).

DESCRIPTION OF DEFECT TIMESCALE FOR REPAIR, RENEWAL OR

ALTERATION (IF IMMEDIATE STATE "NOW")

DESCRIPTION OF TESTS RESULTS OF TESTS

CONDITION OF ROPES AND CHAINS, WHERE APPLICABLE

DECLARATION BY THE COMPETENT PERSON DATE OF PREVIOUS

I HEREBY DECLARE THAT THE EQUIPMENT DESCRIBED IN THIS REPORT WAS THOROUGHLY EXAMINED IN ACCORDANCE WITH EXAMINATION:
LIFTING OPERATIONS & LIFTING EQUIPMENT REGULATIONS (LOLER) 1998
NO FAULTS HAVE BEEN DETECTED - LATEST DATE OF NEXT
FAULTS HAVE BEEN DETECTED AND THE ABOVE ACTIONS ARE REQUIRED WITHIN THE TIME LIMITS SPECIFIED - EXAMINATION:
THE EQUIPMENT MUST NOT BE USED UNTIL THE ABOVE RECOMMENDATIONS ARE CARRIED OUT -

AUTHORISED EXAMINER
NAME: SIGNATURE:

ADDRESS:

QUALIFICATIONS / EMPLOYMENT:

* A COMPETENT PERSON IS EXPECTED TO HAVE AS A MINIMUM; 1) IPAF OPERATOR CERTIFICATE FOR RELEVANT MACHINE, 2) 5+ YEARS EXPERIENCE ON MOBILE
MACHINERY, 3) JCB ACCESS MACHINE TRAINING, 4) EXTERNAL THOROUGH EXAMINATION CERTIFICATE