Annual ANSI Inspection- Boom Truck Cranes

Codes:

# Code # Code

1 31

2 32

3

4 33

34

5 35

6 36

7 37

8 38

9 39

10 40

41

11 42

12

13 43

14 44

15 45

16 46

17 47

18 48

19 49

20

21 50

22 51

23 52

24 53

25 54

26 55

27 56

28 57

58

29 59

30 60

Chassis/ Carrier

Outriggers/ Stabilizers

Operator's Control Station

O- 1926.1412(f)(2)(i) Main Frame and Crossmembers

O- 1926.1412(f)(2)(i) Boxes/ Sub-Frame/ Attachment

O- 1926.1433(d)(6) Fire Extinguisher

O- 1926.1412(f)(2)(xviii)&(xix) Seat

A- B30.5-1.6.3(b) Accelerator/ Throttle

O- 1926.1415(a)(7) Horn

A- PCSA #4 6.1.10.1 Control Identification

O- 1926.1407(g) Electrocution Warning

O- 1926.1412(d)(1) Controls- Force to movement

O- 1926.1433(d)(7)(ii) Door Restraint/ Locks

O- 1926.1412(f)(2)(xxi) Hand Rails, Steps, Platform

O- 1926.1423(c)(3)(ii) Anti-Slip Surfaces

O- 1926.1433(d)(7)(iii) Glass

O- 1926.1412(f)(2)(x) Hydraulic Plumbing, Fittings

O- 1926.1412(f)(2)(xiv) Pads/ Floats/ Storage/ Mounts

O- 1926.1412(f)(2)(xvii) Caution and Warning Decals

O- 1926.1412(f)(2)(i) Beams/ Legs/ Supports

O- 1926.1412(f)(2)(xiii) Cylinders

O- 1926.1412(f)(2)(xii) Holding Valves/ Lock Valves

O- 1926.601(b)(4)(i) Backup Alarm operation

O- 1926.1412(f)(2)(x) Hydraulic Plumbing, Fittings

O- 1926.1412(d)(1)(iv) Hydraulic Fluid level

O- 1926.1423(c)(3)(ii) Anti-Slip Surfaces

O- 1926.601(b)(14) Transmission/ Transfer Case

O- 1926.601(b)(14) Drivelines/ U-Joints

O- 1926.1433(d)(8) Guards and Covers

O- 1926.1412(f)(2)(vi) Oil level, Operation/ Perf.

O- 1926.1433 (d)(9) Exhaust system, guards, shields

Truck/ Carrier Engine- Power Plant- ContinuedO- 1926.1433 (d)(8) Covers, Guards- Moving Parts

O- 1926.1433(d)(8) Belts and Hoses, Clamps

O- 1926.1412(f)(2)(ix) Tires, Wheels, Lug nuts

O- 1926.1412(f)(2)(ix) Tire Air Pressure

Documentation/ Historical Records

General

Truck/ Carrier Cab

Truck/ Carrier Engine- Power Plant

A- B30.5-1.6.4 Clutch

O- 1926.1433(d)(7)(i) Windshield Defroster

O- PCSA #2 8.01 Operator's Manuals

O- 1926.601(b)(1) Parking Brakes

A- B30.5-1.6.3 Accelerator/ Throttle

O- 1926.601(b)(1) Brakes

A- B30.5.2.1.3(a)(10) Steering

O- 1926.601 (b)(3) Horn

A- B30.5-2.1.2 (d) Air Pressure

A- B30.5-2.1.2 Electrical Controls/ Switches

A- B30.5-2.1.3(a)(6) Instruments/ Gauges

A- B30.5-2.1.3 Power Take Off Controls

O- 1926.601(b)(2)(i)&(ii) Windshield Wipers/ Washer

O- 1926.601(b)(9) Seat Belts

O- 1926.1412(f)(2)(xviii)&(xix) Seat

Load Test Records

A- B30.5-3.4.9(a) Fire Extinguisher

O- 1926.601(b)(5) Glass

O- 1926.601 (b)(4) Mirrors

O- 1926.1422 Hand Signal Chart

O- 1926.1412(f)(2)(xvii) Warning Decals/ Placards

O- 1926.1433(d)(8) Covers, Guards, Overall Cond.

O- 1926.601(b)(2)(i&ii) External Lighting

A- B30.5-3.4.7 General Housekeeping

Inspect worksite area for potential hazards, power lines, etc.

R= Recommended

Mileage/ Hr Meter (ECM)R.O. Number

Make the appropriate mark in the status area, provide follow up details as required.

Instructions:Consult operator or service manuals or bulletins as necessary for additional inspection requirements.

Chassis Make-Mod

OSHA and ASME allow only qualified persons who have completed training to inspect cranes.

Equip Number

Providing the BEST equipment in the industry.

References- O = OSHA 1926 Subpart CC, 1926.601, 1910.180 A = ASME B30.5, B30.10

Item Description

O- 1926.1434(a) Modification Records

A- B30.5-2.2.2(a)(2)

O- 1926.1412(f)(2)(ii) Monthly Inspection Records

Branch

Date

VIN

Serial NumberUnit Make-Mod

A- B30.5-2.3.1(a) Maintenance Records

Company/ Owner

N- Not Applic.

Reference ReferenceItem Description

A= Acceptable, OK X= Safety Hazard M= Monitor

Page 1 of 4

Annual ANSI Inspection- Boom Truck Cranes

Codes:

# Code # Code

61 99

62 100

63 101

64 102

65 103

66

67

68

69

70

71

72 104

105

73 106

74 107

75 108

76 109

77 110

78 111

79 112

80 113

81 114

82 115

83

84

85

86

87

88

89 116

90 117

91 118

92 119

93 120

94 121

95 122

96 123

97 124

98 125

NDT Results

Other

Model Number:

0* Hook Bend or Twist

5% Hook Opening or 1/4" Max.

10% Hook Wear Max.

NDT Results

Other

Weight Marking

Safety Latch(s)

Swivel/ Bearing

Wedge Socket/ End Fitting

Serial Number:

Rated Capacity:

Other

Serial Number:

Rated Capacity:

Block Weight:

Hook Tram Measurement:

Wedge Socket/ End Fitting

Reeving/ Retainers

0* Hook Bend or Twist

5% Hook Opening or 1/4" Max.

10% Hook Wear Max.

Capacity Marking

Weight Marking

Safety Latch(s)

Bearings

Sheaves

Overhaul/ Downhaul Ball and HookManufacturer:

O- 1926.1433(d)(3)

O- 1926.1433(d)(3)

Reference Item Description Reference Item Description

O- 1926.1412(d)(1)(vi)

Main Boom

A - B30.10-1.10.5(g)

A - B30.10-1.10.5(e.)

A -B30.5-2.1.3 (i)

O- 1926.1414(f)&(g)

A - B30.10-1.10.5(f)

O- 1926.1412(f)(2)(ii) Sheaves/ Rollers/ Retainers

O- 1926.1413(a)(2)(i)(D) Wire Rope/ Cable Retainers

O- 1926.1413(a)(2)(i)(D)

A - B30.10-1.10.5(e.)

A -B30.5-2.1.3 (i)

O- 1926.1414(f)&(g)

A - B30.10-1.10.5(f)

O- 1926.1412(f)(2)(xii) Holding Valves/ Lock Valves

O- 1926.1412(f)(2)(i) Structure

O- 1926.1412(f)(2)(iii) Boom Hinge Pin/ Pivot Point

O- 1926.1412(f)(2)(xiii) Lift Cylinder and Pins

Block Weight:

Hook Tram Measurement:

O- 1926.1433(d)(3)

O- 1926.1433(d)(4)

O- 1926.1412(f)(2)(iii)

A- B30.5-1.1.2(f) Hoist/ Winch Spooling

O- 1926.1413(a)(4)(i)(B) Hoist/ Winch min. 2 rope wraps

O- 1926.1433(d)(13) Hoist/ Winch Brake

O- 1926.1412(f)(2)(xiii) Telescoping Cylinder/ Attach.

O- 1926.1412(f)(2)(x) Hydraulic Plumbing, Fittings

Hoist/ Winch Line Dead End

O- 1926.1412(f)(2)(i) Boom Head Section

O- 1926.1412(f)(2)(i) Boom Sections Alignment

O- 1926.1412(f)(2)(xv) Wear Pads/ Shims/ Attachment A - B30.10-1.10.5(g)

O- 1926.1433(d)(4)

O- 1926.1412(f)(2)(iii)

O- 1926.1412(f)(2)(ii)

O- 1926.1412(f)(2)(i) Mounting

O- 1926.1412(f)(2)(i) Turret

O- 1926.1412(f)(2)(iii) Turntable

O- 1926.1412(f)(2)(x) Hydraulic Plumbing/ Fittings

O- 1926.1412(f)(xi)(A) Hydraulic Pressure

O- 1926.1412(f)(2)(xi) Hoist/ Winch Motor, Valves

Other

Load Block/ Multi-Sheave Block and HookManufacturer:

Model Number:

O- 1926.1412(f)(2)(xi) Hydraulic Pumps/ Motors

Jib/ ExtensionsO- 1926.1412(f)(2)(i) (A) Structure

O- 1926.1413(a)(2)(i) (D) Wire Rope/ Cable Retainers

O- 1926.1412(f)(2)(iii) Pins and Locking Devices

O- 1926.1415(a)(3) Positive Stops

O- 1926.1412(f)(2)(ii) Sheaves

O- 1926.1407(g) Electrocution Warning Decal

O- 1926.1412(f)(2)(xvi) Electrical Wiring

O- 1926.1412(f)(2)(xi) Swing/ Rotation Gearbox

O- 1926.1416(e)(5)(ii) Winch Drum Rotation Indicator

O- 1926.1416(e)(4) Overload Protection

Upper Structure

O- 1926.1415(a)(1) Crane Level Indicator

O- 1926.1416(e)(1) Boom Angle Indicator

O- 1926.1416(e)(3) Boom Length Indicator

Safety Devices/ Operational AidsO- 1926.1416(d)(3)(i) Anti-Two Block Device

O- 1926.1416(e)(5)(i) Outrigger/ Stabilizer Pos. Sensor

O- 1910.180(c )(2) Durable

O- 1910.180(c )(2) Secured

O- 1926.1417(c )(1) Visible from Operator's Station

Load ChartO- 1926.1433(d)(1) Per Configuration

O- 1910.180(c )(2) Legible

References- O = OSHA 1926 Subpart CC, 1926.601, 1910.180 A = ASME B30.5, B30.10

A= Acceptable, OK X= Safety Hazard M= Monitor R= Recommended N- Not Applic.

Page 2 of 4

Annual ANSI Inspection- Boom Truck Cranes

Codes:

Type SizeMeasure

Wear

Broken

WiresLubricate Code

# Code

126

127

Parts of Line Rated Capacity

# X/M/R

Results of Load Test- oPassed oFailed oNot Applicable

Explanation-

X= Safety Hazard M= Monitor R= Recommendation

Initials DateFollow Up/ Deficiency/ Corrective Action

A- B30.5-2.2.2 Load Test

Hoisting From:

Main Boom

Jib

Boom Angle Load Radius% of Rated

CapacityTest WeightBoom Extension/ Jib Length

Caution: Operation of cranes by Inspectors is limited to only those functions

required to accomplish the inspection. Inspectors must meet operator trainee

qualification requirements IAW ASME B30.5 and only operate with the direct

supervision of a certified operator.

A= Acceptable, OK X= Safety Hazard M= Monitor R= Recommended N- Not Applic.References- O = OSHA 1926 Subpart CC, 1926.601, 1910.180 A = ASME B30.5, B30.10

A- B30.5-2.1.1 No Load Operational Test

Reference Item Description

A- B30.5-2.1.1 No Load Operational Test

Core

O- 1926.1413 Wire Rope/ Cable Inspection

End

Connections

Rope

Application

Primary Hoist

Auxiliary Hoist

Pendants

Other

Constr. Grade

The following discrepancies shall be corrected by a qualified person IAW manufacturer's and OSHA/ ANSI

regulations. Any Safety Hazard must be corrected before the unit is returned to service.

Follow Up/ Deficiency Details

Instructions:

Page 3 of 4

Annual ANSI Inspection- Boom Truck Cranes

# X/M/R

Confirmation of Inspection

Receipt:

By signing below, the owner or owner's representative verifies that they have received

the inspection, inspection summary and discrepancy details.

Name of Owner or Representative Signature of Owner or Representative Date

Instructions: The following discrepancies shall be corrected by a qualified person IAW manufacturer's and OSHA/ ANSI regulations. Any Safety Hazard must be corrected before the unit is returned to service.

X= Safety Hazard M= Monitor R= Recommendation

Follow Up/ Deficiency/ Corrective Action Initials Date

Name of Technician Completing Inspection Signature of Technician Completing Inspection Date

Confirmation of Inspection

Completion:

By signing below, the inspecting technician verifies that they have completed all

inspection tasks IAW company policies and manufacturer's guidelines.

Page 4 of 4

Equip NumberRow1: Company OwnerRow1: Chassis MakeModRow1: VINRow1: BranchRow1: RO NumberRow1: Mileage Hr Meter ECMRow1: Mileage Hr Meter ECMRow1_2: Unit MakeModRow1: Serial NumberRow1: DateRow1: Monthly Inspection Records: Covers Guards Moving Parts: Maintenance Records: Belts and Hoses Clamps: Modification Records: Load Test Records: Main Frame and Crossmembers: Tires Wheels Lug nuts: Inspect worksite area for potential hazards power lines etc: Tire Air Pressure: Covers Guards Overall Cond: Transmission Transfer Case: External Lighting: Drivelines UJoints: General Housekeeping: Guards and Covers: Hand Signal Chart: Hydraulic Plumbing Fittings: Warning Decals Placards: Hydraulic Fluid level: AntiSlip Surfaces: Fire Extinguisher: Backup Alarm operation: Glass: Mirrors: Boxes SubFrame Attachment: Windshield Wipers Washer: Beams Legs Supports: Seat Belts: Cylinders: Seat: Holding Valves Lock Valves: Electrical Controls Switches: Hydraulic Plumbing Fittings_2: Instruments Gauges: Pads Floats Storage Mounts: Power Take Off Controls: Caution and Warning Decals: Steering: Horn: Fire Extinguisher_2: Air Pressure: Glass_2: Parking Brakes: Door Restraint Locks: Accelerator Throttle: Hand Rails Steps Platform: Brakes: AntiSlip Surfaces_2: Clutch: Control Identification: Windshield Defroster: Electrocution Warning: Operators Manuals: Controls Force to movement: Accelerator Throttle_2: Oil level Operation Perf: Horn_2: Exhaust system guards shields: Seat_2: Per Configuration: Legible: Durable: Secured: Visible from Operators Station: AntiTwo Block Device: Outrigger Stabilizer Pos Sensor: Crane Level Indicator: Boom Angle Indicator: Boom Length Indicator: Winch Drum Rotation Indicator: Overload Protection: Mounting: Turret: Turntable: Electrocution Warning Decal: Electrical Wiring: Swing Rotation Gearbox: Hydraulic Pumps Motors: Hydraulic Plumbing Fittings_3: Hydraulic Pressure: Hoist Winch Motor Valves: Hoist Winch Spooling: Hoist Winch min 2 rope wraps: Hoist Winch Brake: Structure: Boom Hinge Pin Pivot Point: Lift Cylinder and Pins: Telescoping Cylinder Attach: Hydraulic Plumbing Fittings_4: Holding Valves Lock Valves_2: Boom Head Section: Boom Sections Alignment: Wear Pads Shims Attachment: Sheaves Rollers Retainers: Wire Rope Cable Retainers: Hoist Winch Line Dead End: Structure_2: Wire Rope Cable Retainers_2: Pins and Locking Devices: Positive Stops: Sheaves: Manufacturer: Model Number: Serial Number: Rated Capacity: Block Weight: Hook Tram Measurement: Capacity Marking: Weight Marking: Safety Latchs: Bearings: Sheaves_2: Wedge Socket End Fitting: Reeving Retainers: 0 Hook Bend or Twist: 5 Hook Opening or 14 Max: 10 Hook Wear Max: NDT Results: Other_2: 115Row1: Manufacturer_2: Model Number_2: Serial Number_2: Rated Capacity_2: Block Weight_2: Hook Tram Measurement_2: Weight Marking_2: Safety Latchs_2: Swivel Bearing: Wedge Socket End Fitting_2: 0 Hook Bend or Twist_2: 5 Hook Opening or 14 Max_2: 10 Hook Wear Max_2: NDT Results_2: Other_3: A B305213 i125: Other_4: TypePrimary Hoist: SizePrimary Hoist: ConstrPrimary Hoist: GradePrimary Hoist: CorePrimary Hoist: Measure WearPrimary Hoist: Broken WiresPrimary Hoist: LubricatePrimary Hoist: End ConnectionsPrimary Hoist: CodePrimary Hoist: TypeAuxiliary Hoist: SizeAuxiliary Hoist: ConstrAuxiliary Hoist: GradeAuxiliary Hoist: CoreAuxiliary Hoist: Measure WearAuxiliary Hoist: Broken WiresAuxiliary Hoist: LubricateAuxiliary Hoist: End ConnectionsAuxiliary Hoist: CodeAuxiliary Hoist: TypePendants: SizePendants: ConstrPendants: GradePendants: CorePendants: Measure WearPendants: Broken WiresPendants: LubricatePendants: End ConnectionsPendants: CodePendants: TypeOther: SizeOther: ConstrOther: GradeOther: CoreOther: Measure WearOther: Broken WiresOther: LubricateOther: End ConnectionsOther: CodeOther: No Load Operational Test127: Boom AngleMain Boom: Load RadiusMain Boom: Parts of LineMain Boom: Rated CapacityMain Boom: Test WeightMain Boom: of Rated CapacityMain Boom: Boom AngleJib: Load RadiusJib: Parts of LineJib: Rated CapacityJib: Test WeightJib: of Rated CapacityJib: Results of Load Test Passed Failed Not Applicable Explanation: Row1_5: XMRRow1: Follow Up Deficiency Corrective ActionRow1: InitialsRow1: DateRow1_2: Row2: XMRRow2: Follow Up Deficiency Corrective ActionRow2: InitialsRow2: DateRow2: Row3: XMRRow3: Follow Up Deficiency Corrective ActionRow3: InitialsRow3: DateRow3: Row4: XMRRow4: Follow Up Deficiency Corrective ActionRow4: InitialsRow4: DateRow4: Row5: XMRRow5: Follow Up Deficiency Corrective ActionRow5: InitialsRow5: DateRow5: Row6: XMRRow6: Follow Up Deficiency Corrective ActionRow6: InitialsRow6: DateRow6: Row7: XMRRow7: Follow Up Deficiency Corrective ActionRow7: InitialsRow7: DateRow7: Row8: XMRRow8: Follow Up Deficiency Corrective ActionRow8: InitialsRow8: DateRow8: Row9: XMRRow9: Follow Up Deficiency Corrective ActionRow9: InitialsRow9: DateRow9: Row10: XMRRow10: Follow Up Deficiency Corrective ActionRow10: InitialsRow10: DateRow10: Row11: XMRRow11: Follow Up Deficiency Corrective ActionRow11: InitialsRow11: DateRow11: Row12: XMRRow12: Follow Up Deficiency Corrective ActionRow12: InitialsRow12: DateRow12: Row13: XMRRow13: Follow Up Deficiency Corrective ActionRow13: InitialsRow13: DateRow13: Row14: XMRRow14: Follow Up Deficiency Corrective ActionRow14: InitialsRow14: DateRow14: Row15: XMRRow15: Follow Up Deficiency Corrective ActionRow15: InitialsRow15: DateRow15: Row1_6: XMRRow1_2: Follow Up Deficiency Corrective ActionRow1_2: InitialsRow1_2: DateRow1_3: Row2_2: XMRRow2_2: Follow Up Deficiency Corrective ActionRow2_2: InitialsRow2_2: DateRow2_2: Row3_2: XMRRow3_2: Follow Up Deficiency Corrective ActionRow3_2: InitialsRow3_2: DateRow3_2: Row4_2: XMRRow4_2: Follow Up Deficiency Corrective ActionRow4_2: InitialsRow4_2: DateRow4_2: Row5_2: XMRRow5_2: Follow Up Deficiency Corrective ActionRow5_2: InitialsRow5_2: DateRow5_2: Row6_2: XMRRow6_2: Follow Up Deficiency Corrective ActionRow6_2: InitialsRow6_2: DateRow6_2: Row7_2: XMRRow7_2: Follow Up Deficiency Corrective ActionRow7_2: InitialsRow7_2: DateRow7_2: Row8_2: XMRRow8_2: Follow Up Deficiency Corrective ActionRow8_2: InitialsRow8_2: DateRow8_2: Row9_2: XMRRow9_2: Follow Up Deficiency Corrective ActionRow9_2: InitialsRow9_2: DateRow9_2: Row10_2: XMRRow10_2: Follow Up Deficiency Corrective ActionRow10_2: InitialsRow10_2: DateRow10_2: Row11_2: XMRRow11_2: Follow Up Deficiency Corrective ActionRow11_2: InitialsRow11_2: DateRow11_2: Row12_2: XMRRow12_2: Follow Up Deficiency Corrective ActionRow12_2: InitialsRow12_2: DateRow12_2: Row13_2: XMRRow13_2: Follow Up Deficiency Corrective ActionRow13_2: InitialsRow13_2: DateRow13_2: Row14_2: XMRRow14_2: Follow Up Deficiency Corrective ActionRow14_2: InitialsRow14_2: DateRow14_2: Row15_2: XMRRow15_2: Follow Up Deficiency Corrective ActionRow15_2: InitialsRow15_2: DateRow15_2: Row16: XMRRow16: Follow Up Deficiency Corrective ActionRow16: InitialsRow16: DateRow16: Row17: XMRRow17: Follow Up Deficiency Corrective ActionRow17: InitialsRow17: DateRow17: Row18: XMRRow18: Follow Up Deficiency Corrective ActionRow18: InitialsRow18: DateRow18: Row19: XMRRow19: Follow Up Deficiency Corrective ActionRow19: InitialsRow19: DateRow19: Row20: XMRRow20: Follow Up Deficiency Corrective ActionRow20: InitialsRow20: DateRow20: Row21: XMRRow21: Follow Up Deficiency Corrective ActionRow21: InitialsRow21: DateRow21: Row22: XMRRow22: Follow Up Deficiency Corrective ActionRow22: InitialsRow22: DateRow22: Row23: XMRRow23: Follow Up Deficiency Corrective ActionRow23: InitialsRow23: DateRow23: Row24: XMRRow24: Follow Up Deficiency Corrective ActionRow24: InitialsRow24: DateRow24: Row25: XMRRow25: Follow Up Deficiency Corrective ActionRow25: InitialsRow25: DateRow25: Row26: XMRRow26: Follow Up Deficiency Corrective ActionRow26: InitialsRow26: DateRow26: Row27: XMRRow27: Follow Up Deficiency Corrective ActionRow27: InitialsRow27: DateRow27: Row28: XMRRow28: Follow Up Deficiency Corrective ActionRow28: InitialsRow28: DateRow28: Row29: XMRRow29: Follow Up Deficiency Corrective ActionRow29: InitialsRow29: DateRow29: Row30: XMRRow30: Follow Up Deficiency Corrective ActionRow30: InitialsRow30: DateRow30: Row31: XMRRow31: Follow Up Deficiency Corrective ActionRow31: InitialsRow31: DateRow31: O 19261413a2iD98: A B305211127: No Load Operational Test: No Load Operational Test 2: Main Boom: Jib: Technician Name: Owner Name: Technician Signature: Owner Signature: Date: CLEAR: A B305213 i115: Other: A B305213 i124: Other 5: Other 6: Text167: Text168: Text169: Text170: Text171: Text172: Text173: Text174: Text175: Text176: Text177: Text178: Text179: Check Box180: OffCheck Box181: OffCheck Box182: Off