Mobile cranes

Inspection form

Version 1, 2015-06-15, SAP No. 4000105669

 INSTRUCTIONS FOR USE

• Complete all items in the form.

• You must specify the reason in the field ‘Remarks’ when
you select ‘Not OK’ for an item.
• Comments and remarks must be entered in the field
‘Remarks’ on the bottom of the page.
• Digitally sign the form with your digital ID, or print the form
and sign the form with a pen and a stamp.

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Version 1, 2015-06-15, SAP No. 4000105669
CRANE INFORMATION

General Crane design

Make Kebelco Carrier On tyres
Model CKE1800 IF On tracks
Year of manufacture 2010 Truck
Serial number JC04-02190 All-terrain
Fleet number 1901 Other:
Engine operation hours:
Carrier NA Boom Telescopic boom parts
Upper structure 14146 Lattice boom 80.38 ft
Jib ft
Owner Runner ft
Name Mammoet Canada Western Back mast ft
Address Other:
Office ft
Telephone

INSPECTION INFORMATION

Order number
Date of inspection Mar 9/2023
Location of inspection Site C Dam FSJ BC

Defects? No  Yes

For an overview of the defects refer to category 2000 (last page).
Enter the items that must be repaired or replaced immediately in the field below.
The crane must not be used before these items are repaired or replaced.

Inspector Report handed over to

Name Joel Colter
Company Colter Heavy Duty Ltd.
Date 09/03/2023

Signature

Management Signature
Name
Company
Date

Remarks

PAGE 3 OF 3
Version 1, 2015-06-15, SAP No. 4000105669
INSPECTION ITEMS

Not OK
OK

n/a
0100 General
0101 Crane logbook is available
0102 Crane logbook is completed and signed by
approved inspection organization or manufacurer
0103 > Rated capacity charts are available
0104 Installation, operator and maintenance manuals are
available
0105 Electrical, hydraulic and pneumatic diagrams are
available
0106 Design of the crane is as shown in the crane
logbook
0107 Primary repairs are done correctly
0108 Previous assessment report is available
0109 Outrigger pads are visually in good condition
0110 Other:

Remarks for this page

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Version 1, 2015-06-15, SAP No. 4000105669
 Not OK
OK

n/a
0200 Access area
0201 Steps
0202 Platforms and catwalks
0203 Railings

Crane cabin Driver cabin

Not OK

Not OK
OK

n/a

OK

n/a
0300 Cabin, control location Available Select...
0301 Controls (switches, handles, pedals)
0302 Instruments
0303 Signs at control location
0304 Capacity charts (as shown in the crane logbook)
0305 Load and reach indicators
0306 > Ignition switch and emergency stop
0307 > Crane movements disabled
0308 Safeguard, seat switch, dead man’s switch
0309 Horn
0310 Windscreen wipers
0311 Windspeed indicator
0312 Mirrors
0313 Doors and door locks
0314 Windows (safety glass)
0315 Spirit levels
0316 Heating, ventilation, lights
0317 Fire extinguisher
0318 First aid kit
0319 Spill kit
0320 Other:

Remarks for this page

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Version 1, 2015-06-15, SAP No. 4000105669
 Main boom Aux. boom Back mast Runner

Not OK

Not OK

Not OK

Not OK
OK

n/a

OK

n/a

OK

n/a

OK

n/a
0400 Boom and auxiliary boom Available Select... Select... Select...

0401 Construction, welds

0402 Overall installation
0403 Bolt and pin connections tightened
0404 Sheaves
0405 Rope run out prevention
0406 Boom stops, holding ropes
0407 Guidance of the main boom telescopic sections
0408 Telescoping chain or wire rope
0409 > Installation
0410 > Sheaves
0411 > Periodic inspection done
0412 Other:

Not OK
OK

n/a
0500 A-Frame Available

0501 Construction, welds

0502 Installation on the frame
0503 Bolt and pin connections tightened
0504 Sheaves of the lower block
0505 Rope run out prevention, lower block
0506 Connection of the lower block
0507 Sheaves of the upper block
0508 Rope run out prevention, upper block
0509 Connection of the upper block
0510 Other:
Not OK
OK

n/a

0600 Slewing assembly Available

0601 Slewing bearing

0602 Bolts of the slewing bearing
0603 Pinion gear(s), drive
0604 Brake(s)
0605 Locking pin
0606 Other:
Remarks for this page

PAGE 1 OF 2
Version 1, 2015-06-15, SAP No. 4000105669
 Not OK

Not OK

Not OK

Not OK

Not OK

Not OK
OK

n/a

OK

n/a

OK

n/a

OK

n/a

OK

n/a

OK

n/a
0700 Wire ropes and sheaves Available Not available Available Available Select... Select...
Name of the winch
Boom JIB FR RE

Running wire ropes

Diameter of the wire ropes
> As shown in the crane logbook
> Measured 24.7 26.0 22.2 22.4
0701 Wire ropes are as shown in the crane
logbook
0702 Certificate is as shown in the crane
logbook
0703 Crane logbook shows that the wire
rope is regularly inspected
0704 Wire rope is visually in good condition
0705 No rub and wear marks visible in the
wire track
0706 Wire ropes correctly tightened
0707 Wedge clamp correctly tightened
0708 Lock behind the wedge clamp
correctly installed
0709 Other:

Pendants Select... Select... Select... Select... Select... Select...

Diameter of the pendants
> As shown in the crane logbook
> Measured 26.0
0710 Pendants are as shown in the crane
logbook
0711 Certificate is as shown in the crane
logbook
0712 Crane logbook shows that the
pendants are regularly inspected
0713 Pendants are visually in good
condition
0714 Pendants are correctly tightened
0715 Cable eyes have thimbles
0716 Bolt connections tightened at the
thimbles
0717 Other:

Remarks for this page

All 8 Pendants measured 26.0mm +-0.2mm

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Version 1, 2015-06-15, SAP No. 4000105669
 Not OK

Not OK

Not OK

Not OK

Not OK

Not OK
OK

n/a

OK

n/a

OK

n/a

OK

n/a

OK

n/a

OK

n/a
0800 Winches Select... Select... Select... Select... Select... Select...
Name of the winch
Boom JIB FR RE

0801 Drive, bearing, free wheel clutch

0802 Brake
0803 Drum, bearing
0804 Rope run out prevention

Not OK

Not OK

Not OK
OK

n/a

OK

n/a

OK

n/a
0900 Hooks and blocks Select... Select... Select...
Description of the hook block Hook Block
160Te
Mammoet equipment number 001901
Rated capacity shown on the hook block 160
Identification number on the hook block 5334625
Y-measurement
> As shown on the certificate Y1
Y2
> Measured Y1 7.5"
Y2 7.5"

0901 Details agree with crane logbook

Hook
0902 Condition of the thrust bearing
0903 Fixing nut locked
0904 Safety latch
0905 General condition (wear, tear, deformation etc.)
Blocks
0906 Sheave groove smooth and free of damage
0907 Rope run out prevention
0908 Shafts are radially and axially locked
0909 Bolts locked
0910 Warning marks
0911 General condition
0912 Other:

Remarks for this page

PAGE 1 OF 2
Version 1, 2015-06-15, SAP No. 4000105669
 Upper struct. Carrier

Not OK

Not OK
OK

n/a

OK

n/a
1000 Upper structure, carrier Select... Select...
1001 Construction, welds
1002 Bolt and pin connections are tightened
1003 Other:

Not OK
OK

n/a
1100 Outriggers and jacks Select...

1101 Construction and welds of the outriggers

1102 Locking device of the outriggers
1103 Condition of the jacks
1104 Locking device of the jacks, holding valve
1105 Condition of the jack plates
1106 Locking device of the jack plates
1107 Warning stripes and jack width marks on the
outriggers
1108 Other:
Not OK
OK

n/a

1200 Front and rear axles Select...

1201 Front axle(s) suspension and spring

1202 Rear axle(s) suspension and spring
1203 Wheel nuts and studs
1204 Condition of the tyres, tire pressure
1205 Suspension lock and pendulum operation
1206 Other:

Left Right
Not OK

Not OK
OK

n/a

OK

n/a

1300 Crawlers Select... Select...

1301 Connection to the chassis
1302 Connection to the sprocket wheels and tensor
wheels
1303 Chain links of the tracks
1304 Tension of the tracks
1305 Other:
Remarks for this page

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Version 1, 2015-06-15, SAP No. 4000105669
 Not OK
OK

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1400 Steering and brake assembly
Select...
1401 Play in the steering
1402 Parking brake
1403 Service brake
1404 Brake cylinders, boosters
1405 Hoses, pipes and couplings
1406 Other:

Upper struct. Carrier

Not OK

Not OK
OK

n/a

OK

n/a
1500 Electrical installation Select... Select...
1501 Operation and road lights
1502 Electrical cables and wires
1503 Slip ring assembly
1504 Switchboard and equipment
1505 Batteries
1506 Other:

Upper struct. Carrier

Not OK

Not OK
OK

n/a

OK

n/a
1600 Hydraulic and pneumatic installation Select... Select...
Hydraulic installation
1601 Hoses, pipes and couplings
1602 Main-boom luffing cylinder(s)
1603 > Pipe and hose rupture protection
1604 Telescope cylinders
1605 > Pipe and hose rupture protection
1606 Jack cylinders
1607 > Pipe and hose rupture protection
1608 Suspension, pendulum arrest cylinders
1609 > Pipe and hose rupture protection
1610 Outrigger cylinders
1611 Pumps, motors and valves
1612 Other:

Remarks for this page

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Version 1, 2015-06-15, SAP No. 4000105669
 Not OK
OK

n/a
1700 Miscellaneous Select...
1701 Connection of the counterweight
1702 Counterweight mass is as shown on the capacity
chart
1703 Condition of the paintwork
1704 Warning signs and colors marks
Marks
1705 > Identification
1706 > Tyre pressure
1707 > Mass of the counterweight
1708 Other:

Main boom Aux. boom Runner

Not OK

Not OK

Not OK
OK

n/a

OK

n/a

OK

n/a
1800 Automatic limiters, cut-outs Available Select... Select...

1801 Hoist limiter

1802 Reeving limiter
1803 Luff in limiter (max. angle, min. reach)
1804 Luff out limiter (min. angle)
1805 Telescope out
1806 Counterweight protection
1807 Slewing lock pin protection
1808 Slew angle limiter, working area limiter
Load Moment Limitor (LML)
1809 LML cutout hoisting
1810 LML cutout luff in
1811 LML cutout telescope out
1812 LML pre-warning
1813 LML warning
1814 Override switch cannot be locked
1815 Program setting LML clearly visible
1816 Instructions LML clearly visible
1817 LML settings (see 1900)
1818 Other:

Remarks for this page

5.8m Min
29.8m Max

PAGE 2 OF 2
Version 1, 2015-06-15, SAP No. 4000105669
Version 1, 2015-04-17, SAP No. 4000105669

PAGE 4 OF 4 1900 Test table

Details as per hoisting table LMB-test

Crane is on Boom length Boom angle Slew angle Ballast

Known Test Weight (incl. hook

LML is activated at a radius of

LML test OK? (Within %10)

Radius (ft) From load chart

block and rigging) (lb)

Total boom length (ft)

Mass superstructure
counterweight (lb)

counterweight (lb)
Mech. section (ft)

Number of parts
Main boom (ft)

Mass superlift
Main boom (°)
Test number

LML code
Jib (m)

Jib (°)

(ft)
1 Select... Select... Select...

2 Select... Select... Select...

3 Select... Select... Select...

4 Select... Select... Select...

5 Select... Select... Select...

6 Select... Select... Select...

7 Select... Select... Select...

Remarks for this page

2000 Overview

Version 1, 2015-06-15, SAP No. 4000105669