CRANE SITE PERIODIC INSPECTION FORM (BI ANNUALLY)

Inspection Date Date Signature

Vehicle Type Plate NO: Company

INSPECTION ITEMS YES NO REMARKS
Is the periodic inspection report of the machine up to date ?
Do you have the operator's certificate?

Do all lifting equipment (such as sling, eyebolt, rope, etc.) used in the
machine have a certificate?

Are all lifting equipment (such as sling, eyebolt, rope, etc.) used in the
machine undamaged and suitable for use?

Was the operator informed about the application by briefing about the
"Construction Machinery Daily Inspection Form"?

Has "Safe Driving Training" been given to the operator? Is the Safe
Driving and Equipment Control Card hung on the vehicle?

Is there a limit switch on the machine and is it active?

Is there a load diagram on the machine?

Is the reversing audible warning alarm active?

Is there any oil / fuel leakage in the hydraulic and other parts of the
machine?

Is the headlight, turn signal, horn, wiper, beacon lamp in active working
condition?

Are the cab, windows and rear view mirrors intact?

During the lifting operation, was the operator informed that the lifting
operation should not be carried out without fully opening the crane legs?

Is there an underfoot wedge in the crane and does it comply with the
required standards? Has the operator been informed that lifting
operation should not be performed without wedges under the feet?
Are the tires undamaged and suitable for use?

Has the general condition of the machine been checked? Has it been
determined that there is no defect?

Is the first aid kit available and complete?

Is there a fire extinguisher? Is the pressure appropriate?

Are the Operator's Helmet / Goggles / Reflective Vest / Work Shoes

available and comply with the standards?

EXPLANATION

If any deficiencies or malfunctions are detected in the above-mentioned issues, the machine will not be taken to
the field in case of major findings, a deadline will be given to the other party in minor findings, the deficiencies will
be corrected, and if no action is taken until the relevant date, the equipment will be taken out of the field. The
follow-up and process management of the said deadline belongs to the Occupational Safety Specialist who filled
out this form.