Title: HMS Document Number:

Mobile Crane Shift Inspection FO-GL-HAL-HSE-0420B

Owner: Approver: Rev Date: Rev No: Page:
Global HSE Director, Global HSE Standards 17-DEC-2020 0 1 of 2

Unit# 11248585 SO#908774506 Customer: SH - DP

Complete and turn in with daily trip sheet

Note: Inspection should not include the removal of access plates etc. unless warranted by condition of equipment.

Okay Adjust Repair

Chassis
Check hydraulic hoses and tubing for wear, leaks, proper & secure installation.
Check hydraulic oil tank for proper fluid level.
Check stabilizer cylinders for proper fluid level.
Check stabilizer attaching bolts for proper and secure installation.
Check inflation and condition of tires
Pedestal
Check controls for legible labels, proper & secure installation, excessive free play & proper operation
while engine is running.
Check hydraulic hoses and tubing for wear, leaks, proper & secure installation.
Check cylinders for proper operation while engine is running.
Check swing hub attaching bolts for proper and secure installation.
Boom
Check placards and decals for proper and secure installation, visible damage and legibility, load chart
visible to the operator.
Check boom angle indicator for proper and secure installation, freedom of movement and proper
operation.
Check winch cable for excessive wear or damage.
Check winch cable end clevis for proper and secure installation and for any damage.
Check safety latch on lifting hook for proper installation and proper operation.
Check winch for proper and secure installation, and proper operation while engine is running.
Check boom sheaves for proper and secure installation and freedom of movement.
Check hook block assembly for proper and secure installation, structural damage, cracked or broken
welds and bent or warped surfaces, throat opening.
Check boom extension and retraction for smooth and correct operation.
Check anti-two block device for damage, proper and secure operation by inching the block or ball into
the anti-two block weight.
Safety Equipment
Full body harness and shock absorbing lanyard.
Inspect all lifting devices; dispose of any lifting device not passing inspection.
Check that manufacturer operation manual is in unit.
Check that annual inspection is current. Date:____________ Customer required copy of inspection report
is in unit.
Check that lifting equipment inventory register is complete.
Check that tagline, push/pull poles or load guiding devices in good condition.
Check for any power-lines in the area?

Explanation of probleme _Throttil and crane limit switch are not workig______
_________________________________________________________________________________________

Repairs completed: Yes No N/A

Repairs certified by:

Date: Qualified Crane Operator’s Signature: SAID ZEGHIDI Date:

Printed versions of this document are considered UNCONTROLLED.

 Title: HMS Document Number:
Mobile Crane Shift Inspection FO-GL-HAL-HSE-0420B
Owner: Approver: Rev Date: Rev No: Page:
Global HSE Director, Global HSE Standards 17-DEC-2020 0 2 of 2

Note: These forms can be ordered from Halliburton’s Qualitrack System by accessing the page below and clicking on the
‘Forms Catalog’ link (Form # 37213). http://halliburton.ridgways.com

Revision Date Rev. No Revised By Summary of Key Changes

Nathan Gatewood Initial release

For questions, comments or previous versions of this document please send using the GHSE Support Request Form.

Printed versions of this document are considered UNCONTROLLED.