EOMD-003-1 REF.

NO: DI-PUIC-AC
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : AIR COMPRESSOR
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
RATED POWER :__________________________________
RUNNING HOURS :___________________________________

ITEMS INSPECTED/TESTED OK Not OK REPLACED

(check one)
CHECK BEFORE STARTING
1 Check crankcase engine oil
2 Check engine cooling system
3 Check air cleaner element
4 Check air compressor oil
5 Check compressor air intake filter
6 Chk battery electrolytes/terminal conn
7 Check tachometer drive
8 Check engine cooling fins
9 Check electrical wiring, lights, etc.
10 Check drive belts tension
11 Check compressor oil
12 Engine cooling system
13 Check fuel tank sediments
14 Check starter assembly

CHECK AFTER STARTING

1 Overspeed governor
2 Inspect throttle controls
3 Overspeed governor
4 Check pump and seals
5 Pressure gauges undamaged and functional
6 No unusual noses or abnormal function
7 Emergency stop functional
8 Check all monitor are functioning

REMARKS:

Repairs or adjustments needed Repairs or adjustments NOT needed

for safe equipment operation
CONDITION OF THE ABOVE EQUIPMENT IS SATISFACTORY
Operator:________________________________ Signature: Date:
Service Technician:________________________ Signature: Date:
Service Mechanics:________________________ Signature: Date:
This document is a sole property of DATEM INCORPORATED
Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-BPB
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : BACKHOE,PAYLOADER AND BULL DOZER
Brand/Model :____________________ PLATE NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CAPACITY/PASS.:_______________________________________
RUNNING HOURS/KM RUN:_____________________________ TYPE:_______________________________
OK = Good Condition RR = Requires Repair FR = For Replacement
OK RR FR ITEM INSPECTED/TESTED OK RR FR ITEM INSPECTED/TESTED
Engine(check leaks and oil level) Check fuel line,hoses and fitting
Radiator (check leaks/coolant Check hydraulic transmission
level when COLD) Check hydraulic hoses/tank and
Check wheels/Tires/Lugs cylinder
Check air cleaner Boom/bucket welds/broken,
Check engine belts loose,missing parts
Battery fluid level Chassis lubricated
Battery terminals and accessories Check Interlock Control System
Exhaust system Check Window, Doors and Lights
Check steering and throttle Check control labels
Check Roll-over protection Check all brake

REMARKS:

ABOVE DEFECTS CORRECTED

ABOVE DEFECTS NEED NOT BE CORRECTED FOR SAFE OPERATION OF VEHICLE

OPERATOR'S NAME & SIGNATURE:___________________________________

CONDITION OF THE ABOVE VEHICLE IS SATISFACTORY

MECHANIC'S NAME & SIGNATURE:________________________________

TECHNICIAN'S NAME & SIGNATURE:________________________________

This document is a sole property of DATEM INCORPORATED

Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
__________
EOMD-003-1 REF. NO: DI-PUIC-CP
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : CONCRETE PUMP
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
RATED POWER :____________________________________
RUNNING HOURS :____________________________________
OK = Good Condition RR = Requires Repair FR = For Replacement

OK RR FR ITEM INSPECTED/TESTED OK RR FR ITEM INSPECTED/TESTED

HYDRAULIC SYSTEM ENGINE PART

Check hydraulic hoses Check engine for oil leaks
Check fluid filter Check battery and battery
Check hydraulic fluid radiator accessories
and check function Check all filter
Check centralized lubrication Check oil level
system Check engine manual throttle
Check hydraulic pump and motor lever
Check the grease reservior Check engine stop and switches
Check hydraulic indicators

AGITATOR COOLING SYSTEM

Check agitator cut-out Check radiator for leak
Check mixer shaft bearing Check radiator coolant level
Check S-transfer tube Check radiator hoses
Check delivery cylinder Check flushing water pump
Check pressure connection Check cooling fan,belt and pulley
Check water box
Check transfer tube damping
Check agitator,helix and shaft
Check vibrator
Check agitator lever
 CONTROL SYSTEM SUPPORT MECHANISM
Check output controller Check support leg w/ support foot
Check all control Check support wheel
Check all monitor and gauges Check trailer coupling ring
Check accumulator accessories Check working light
Check control cabinet
Check all switch connector

REMARKS:

ABOVE DEFECTS CORRECTED

ABOVE DEFECTS NEED NOT BE CORRECTED FOR SAFE OPERATION OF VEHICLE

OPERATOR'S NAME & SIGNATURE:___________________________________

CONDITION OF THE ABOVE VEHICLE IS SATISFACTORY

MECHANIC'S NAME & SIGNATURE:________________________________

TECHNICIAN'S NAME & SIGNATURE:________________________________

This document is a sole property of DATEM INCORPORATED

Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-TC
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : CONCRETE BATCHING PLANT
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CUM/HOUR :____________________________________
CUM/CAP :____________________________________ TYPE:

ITEMS INSPECTED/TESTED OK Not OK REPLACED

(check one)
MIXER
1 Check inside of the mixer before starting operation keep the
strange materials out of the mixer

2 Check keep closed the maintenance cover before starting

operation
3 Check oil level in hyd unit of mixer discharging gate if
necessary add oil
Check bolts of mixing paddle scraper arms must be tighteen
4 with 400nm torque at the end of working day

5 Wash inside of the mixer and keep it clean from the concrete
6 Check lever of discharging gate for manual operations
7 Check the oil level of mixer gearbox
8 Check the automatic grease pump level if necessary add
grease

9 Check and clean the loadcell from dusty keep clean always

10
Check loadcells earling properly or not fasten cable bolts
11 Check the cement weighing batcher output hoses clean
always
CEMENT WEIGHING BATCHER
1 Check the discharge gate of the cement batcher
2 Check loadcells earling properly or not fasten cable bolts
3 Check any sharp object on the conveyor belt
4 Check safety bolts should be loosen to avoid effect weighing
operation

5 Check
always
the cement weighing batcher output hoses clean

WATER WEIGHING BATCHER

1 Check and clean the loadcell from dusty keep clean always
2 Check safety bolts should be loosen to avoid effect
3 Check loadcells earth properly or not fasten cable bolts
4 Check water weighing batcher hoses if necessary renew
them
5 Check if defect leak in water work repair them

6 Check and clean sideway of weighing hopper hangers with

dry air and lubricate them
 ADDITIVE WEIGHING BATCHER
1
Check and clean the loadcell from dusty keep clean always

2 Check additive weighing batcher loadcell bolts if loose

tighten
3 Check if detect leak in additive work repair them
4 Check and detect if leak in hoses repair if necessary
5 Check
detect
additive weighing batcher output hoses if leakage

6 Check loadcells properly or not fasten cable bolts renew

them
7 Check if detect leaking water work repair them
8 Check and clean sideway of weighing hopper bangers with
dry air and lubricate them

CEMENT SCREW
1 Check and greasing screw bearing
2 Check the sealing of screw

CEMENT SILO
1 Check visual inspection of cement silo
2 Check the pneumatic air leakage
3
Check the butterfly valve manually at the bottom of
cement silo

AIR COMPRESSORPNEUMATIC
1 Check leakage of pneumatic system
2 Check and drain off the tank compressor
3 Check compressor if gauge is 6-8 bar
4 Check the oil level of compressor

Repairs or adjustments needed Repairs or adjustments NOT needed

for safe equipment operation

CONDITION OF THE ABOVE EQUIPMENT IS SATISFACTORY

Operator:________________________________ Signature: Date:

Service Technician:________________________ Signature: Date:
Safety Officer: _____________________ Signature: Date:
Equipment Supervisor: _____________________ Signature: Date:
Project/Site Manager: ______________________ Signature: Date:
Service Mechanic:________________________ Signature: Date:
This document is a sole property of DATEM INCORPORATED
Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-GS
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : GENERATOR SET
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
RATED POWER :__________________________________
RUNNING HOURS :___________________________________

ITEMS INSPECTED/TESTED OK Not OK REPLACED

(check one)
SECTION A - COOLING SYSTEM
1 Engine coolant level
2 Radiator core/heat exchanger
3 Coolant lines,connection and hoses
4 Water jacket heater
5 Fan
6 Fan pulley, belt, belt tension

SECTION B - D.C. ELECTRICAL SYSTEM

1 Battery electrolyte level/specific gravity
2 Battery compartment/heater cooperation
3 Battery connections/cables/casing
4 Shutdown mechanisms
5 Electrical starter/alternator generator
6 Electrical system, accessories & components

SECTION C - A.C. ELECTRICAL SYSTEM

1 A.C. wiring
2 Battery charger
3 Control panel/switchgear
4 A.C. generator voltage regulator
5 Electrical system accessories & components

SECTION D - AIR INDUCTION & EXHAUST SYSTEM

1 Air cleaner units/oil bath and dry type
2 Air induction piping and connections
3 Turbocharger/blower
4 Exhaust manifold/piping/connections

SECTION E - POWER UNIT

1 Generator structure
2 Clutch assembly
3 Coupling
SECTION F - LUBRICATION SYSTEM
1 Engine oil level
2 Engine oil change
3 Engine oil filter change
4 Crankcase pressure
5 Crankcase breather
6 Oil leaks (hoses, connections)
7 Engine governor oil level/linkage
8 Fan drive bearing
9 Gauges and safety mechanism
10 Accessory drives

SECTION G - FUEL SYSTEM

1 Fuel tank/day tank
2 Fuel filters-primary/secondary
3 Fuel system components/hoses/piping
4 Gauges and Safety mechanism
5 Condensationj/water in fuel

REMARKS:

Repairs or adjustments needed Repairs or adjustments NOT needed

for safe equipment operation

CONDITION OF THE ABOVE EQUIPMENT IS SATISFACTORY

Operator:________________________________ Signature: Date:

Service Technician:________________________ Signature: Date:
Service Mechanic:________________________ Signature: Date:
This document is a sole property of DATEM INCORPORATED
Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-MC
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : MOBILE CRANE
Brand/Model :____________________ PLATE NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CAPACITY :____________________________________
BOOM/JIB LENGTH:_________________________________ TYPE:_______________________________

ITEMS INSPECTED/TESTED OK Not OK REPLACED

(check one)
1 Check hydraulic motor,pump and cylinder
2 Check pressure gauge,pipelines and joints
3 Check safety devices
4 Check moment limiter
5 Check wire rope lubrication
6 Check main boom and derricking cylinder pins
7 Check hoist gear for leakage
8 Check slewing gear for oil leakage
9 Check steering system
10 Check brake system
11 Check wheels allignment
12 Check joints suspension
13 Check the transmission breather cap
14 Check battery and battery accessories
15 Check oil level,water coolant
16 Grease and lubricate
17 Check brake and clutch reservoirs levels
18 Check hyrdraulic hose for leaks/damages
19 Check operation of boom
20 Check outrigger operation

REMARKS:

Repairs or adjustments needed Repairs or adjustments NOT needed

for safe equipment operation
CONDITION OF THE ABOVE EQUIPMENT IS SATISFACTORY
Operator: Signature: Date:
Service Technician Signature: Date:
Service Mechanic: Signature: Date:
Safety Officer : Signature: Date:
This document is a sole property of DATEM INCORPORATED
Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-TSV
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : TRANSPORT TRUCK AND SERVICE VEHICLE
Brand/Model :____________________ PLATE NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CAPACITY/PASS.:_______________________________________
RUNNING HOURS/KM RUN:_____________________________ TYPE:______________________________
OK = Good Condition RR = Requires Repair ZB
OK RR FR ITEM INSPECTED/TESTED OK RR FR ITEM INSPECTED/TESTED
UNDERHOOD INTERIOR
Battery Brakes
Belts and Hoses Steering
Fuel Cap and Leaks Brake Accessories
Fuel Level Brake Fluid Level
Windshield Washer Brake Parking
Motor oil,Power Steering Brake Service
Coolent Level, Hoses Clutch
Muffler Defroster/Heater
Oil Level Gauges
Radiator Level Horn
Air Dryer

EXTERIOR GENERAL
Lights Exhaust
Head - Stop Engine
Tail - Dash Safety Equipment
Turn Indicator Fire Extinguisher
Drive Line Flags-Flares-Fuses
Reflectors Reflective Triangles
Rear End Spare Bulbs and Fuses
Mirrors Frame and Assembly
Hitch Body
Starter Front Axle/A-Frame
Steering Fluid Level
Steering Mechanism
Suspension System
Tire Chains
Tires
Windows
Windshield Wipers
Transmission
Wheels/Rims/Lugs
TRAILER PLATE NO.:_________________________________

OK RR FR ITEM INSPECTED/TESTED OK RR FR ITEM INSPECTED/TESTED

Brake Connections Reflector/Reflector Tape
Brakes Roof
Coupling Devices Suspension System
Doors Straps
Hitch and Safety Chains Tarpaulin
Landing Gear/Trailer Jack Tires
Lights-All Wheels and Rims

BOOM NO.:___________________________________
Inspect cylinder for leakage Check wire rope
Check rods Check base
Check fitting Check stabilizer beams and legs
Check hydraulic pump and Check booms
motor for leakage Check hydraulic hoses
Check tightness of mounting bolts Check hydraulic level
Check transmission/PTO for leakage

REMARKS:

ABOVE DEFECTS CORRECTED

ABOVE DEFECTS NEED NOT BE CORRECTED FOR SAFE OPERATION OF VEHICLE

DRIVER'S :
Signature Over Printed Name

CONDITION OF THE ABOVE VEHICLE IS SATISFACTORY

MECHANIC'S :
Signature Over Printed Name

TECHNICIAN'S :
Signature Over Printed Name
This document is a sole property of DATEM INCORPORATED
Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-MH
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : MAN-MATERIAL HOIST
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CAPACITY :________________________________________
MAX. HEIGHT:_________________________________________ TYPE:_______________________________
OK = Good Condition RR = Requires Repair FR = For Replacement
OK RR FR ITEM INSPECTED/TESTED OK RR FR ITEM INSPECTED/TESTED
ENCLOSSURE/CAGE MAST/TIE-IN
Check buffer spring Check mast allignment
Check safety railing section Check rack lubricant
Check gate roller upper Check bolts and nuts
Check all roller Check wall bracket
Check nuts,washer and screw Check pipe clanp and pin
Check Ttrat door Check frame
Check ladder Check all light Mast Tie Installations
Check pulley wheel
Check guide rail ELECTRICITY BOX/POWER BOX
Check rubber dumper CONTROL UNIT
Check stop plate Check master controller
Check digital panel meter
MOTOR/MACHINERY Check iso resistance of electric
Check rubber pad circuit
Check motor
Check roller COUNTERWEIGHT
Check pinion Check guide roller
Check gear housing Steel wire
Check oil level guage Check buffer spring
Check air filter
Check braking moment CABLE WHEEL/TOP WHEEL
Check isolation resistance of moto Check wire attachment
Check steel wire protelter plaft
Check pulley wheel
Check frame
SAFETY DEVICE Check cable
Check safety switch Check cable support
Check safety capacity Check cable guide
Check cranking lever Check cable basket
Check limit switch cam
Check top limit switch/bottom switch
Check overload device
Frequency conversion should check the connection of power unit
REMARKS:

ABOVE DEFECTS CORRECTED

ABOVE DEFECTS NEED NOT BE CORRECTED FOR SAFE OPERATION OF VEHICLE

OPERATOR'S NAME SIGNATURE:___________________________________

CONDITION OF THE ABOVE VEHICLE IS SATISFACTORY

TECHNICIAN NAME SIGNATURE:____________________________________

SAFETY OFFICER NAME SIGNATURE:________________________________

This document is a sole property of DATEM INCORPORATED

Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-TC
Equipment Operations and Maintenance Department
PREVENTIVE MAINTENANCE
PRE-USED INSPECTION CHECKLIST
Equipment : TOWER CRANE (Luffing & T-Type Crane)
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CAPACITY :____________________________________
BOOM/JIB LENGTH:_________________________________ TYPE:_______________________________

ITEMS INSPECTED/TESTED OK Not OK REPLACED

(check one)

MAST SECTION/FIXING ANGLE

1 Check fixing angle of chassis collar pin split pin
2 Check mast pin and lock pin with split pin
3 Check ladder guard and platform lock bolt
4 Check lubrication point of ring gear if sufficient
5 Check lubrication point of hoisting if sufficient
6 Check lubrication point of luffing if sufficient
7 Check slewing ring and pinion gear

SLEWING/HOISTING/LUFFING SECTION/TROLLEY SECTION

1 Check slewing ring and pinions
2 Check slewing chassis bolts and nut split pins
3 Check hoisting/luffing winch drum status
4 Check gear box of hoisting oil leaks
5 Check gearbox of luffing oil leaks
6 Check gearbox of trolley grease leaks

JIB SECTION
1 Check jib alignment
2 Check joint pin and lock pin of jib foot
3 Check jib foot grease of bushing
4 Check counter jib joint pin and safety lock pin
5 Check ballast blocks lock and safety pin
6 Check of degree if working

PULLEY AND HOOK SECTION

1 Check hook and latch
2 Check hook lubrication point
3 Check pulley of hook block groove depth
4 Check of sling hook lock/trigger
CABIN SECTION
1 Check operating control system alarm
2 Check joystick control
3 Check anemometer/windspeed
4 Check split pins,screws and bolt
5 Check general note

MOTOR AND WIRING

1 Check Slewing motor and blower fan
2 Check condition of hoisting motors/brake torque
3 Check blower fan motor
4 Check condition of luffing/brake torque
5 Check condition of luffing/safety brake torque
6 Check power cable riser
7 Check all electrical wiring is no damages
8 Check condition of luffing motors

SAFETY DEVICES LIMIT SWITCHES

1 Check trolley moment cutout
2 Check hoisting limit cut off
3 Check weighing pulley max load limiter
4 Check Slewing limiter
5 Check Luffing moment cutout
6 Check condition of lightning arrester
7 Check of grounding connection

STEEL WIRE ROPE

1 Check steel wire rope lubrication hoisting
2 Check lubrication of luffing/trolley wire rope
3 Check lubrication of hoisting wire rope
4 Check reeving hoisting/luffing/trolley

REMARKS:

Repairs or adjustments needed Repairs or adjustments NOT needed

for safe equipment operation

CONDITION OF THE ABOVE EQUIPMENT IS SATISFACTORY

Operator:________________________________ Signature: Date:
Service Technician:________________________ Signature: Date:
Safety Officer:________________________ Signature: Date:

This document is a sole property of DATEM INCORPORATED

Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.
EOMD-003-1 REF. NO: DI-PUIC-TC
Equipment Operations and Maintenance Department

ELECTRICAL INSPECTION CHECKLIST

Equipment : TOWER CRANE (Luffing & T-Type Crane)
Brand/Model :____________________ SERIAL NO:__________________
Equip. Location :____________________ NO:_________________________
EQUIPMENT DETAIL: DATE CONDUCTED:
CAPACITY :____________________________________
BOOM/JIB LENGTH:_________________________________ TYPE:_______________________________

ITEMS INSPECTED/TESTED OK REPLACED

FOR REPAIR

ELECTRICAL
1 Check slewing motor
2 Check condition of hoisting motors/brake torque
3 Check trolley/Luffing motor
4 Check riser/power cable
5 Check condition of luffing motors or brake
6 Check terminal block and lugs
7 Check blower fan motor for hoisting
8 Check blower fan motor slewing
9 Check carbon brush with holder for hoisting
10 Check carbon brush with holder for luffing
11 Check cable wire for hoisting motor
12 Check cable wire for slewing motor
13 Check cable wire for luffing motor

LIMIT SWITCHES
1 Check located at trolley winch
2 Check weighing pulley
3 Check winch drum
4 Check slewing limiter
5 Check luffing/ trolley switches
6 Check limit switch tie bar
7 Check joystick control
8 Check panel board cabinet for hoisting
9 Check panel board cabinet for slewing/ trolley
10 Check pilot light
11 Check horn
TELESCOPIC CAGE SECTION
1 Hydraulic unit
2 Cylinder
3 Telescopic accessories
4 Telescopic yoke
5 Check pin and bolt
CABIN SECTION
1 Check operator
2 Check control
3 Check grad rail
4 Check split pins,screws and bolt
MOTOR AND WIRING
1 Slewing motor
2 Check condition of hoisting motors/brake torque
3 Trolley/Luffing motor
4 Check riser/power cable terminal if connection is loose
5 Check condition of luffing motors or mechanism
6 Check power supply voltage
BRAKE AND SAFETY DEVICE
1 Check general note
2 Check moment cutout
3 Check load limiter
4 Hoist limit switches
5 Slewing limiter
6 Luffing/trolley switches
7 Check brake mechanism
8 Check condition of lightning arrester
9 Check safety brake for oil leaks
ROPE
1 Check rope grease
2 Check lubrication of luffing/trolley wire rope
3 Check lubrication of hoisting wire rope
4 Check rope dead-end

REMARKS:

Repairs or adjustments needed Repairs or adjustments NOT needed

for safe equipment operation

CONDITION OF THE ABOVE EQUIPMENT IS SATISFACTORY

Operator:________________________________ Signature: Date:
Service Technician:________________________ Signature: Date:
Safety Officer:________________________ Signature: Date:
This document is a sole property of DATEM INCORPORATED
Any disclosure, unauthorized reproduction or use is strictly prohibited except Note: Accomplished all items
permission from DATEM INCORPORATION. as long as in complete details.