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SAMPLE REPORT
Acme Company 1 Boston Road
Lawrence, MA 01841
Crane & Hoist Inspection Report August 2015
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Crane & Hoist Inspection Report
Table of Contents
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1. Repair quote and Inspection Reports
2. A- Crane Inspection Reports
3. B-Hand Chain Fall Inspection Reports
4. C-Electric Chain Hoist Inspection Reports 5. CS-Chain/Sling Inspection Sheet
5. D-Electric Cable Hoist Inspection Reports
6. E-Blank Inspection Reports 7. F-Charging Bucket Inspection Report 8. G-Pneumatic Chain Hoist Inspection Report
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March 2015 Mr. John Doe Acme Company 1 Boston Road Lawrence, MA 01841 Dear Mr. Doe, As a result of our recent inspections, we found the following deficiencies. We are pleased to offer you this quotation on the material and labor that are necessary to bring your equipment up to safe and efficient working levels. Item #1 – IR #0008A Main Engine Room BECH Bridge S/N 351295 C-M Hoist L-1965 KM
A. Replace push button enclosure (1) B. Replace push button boots (8) C. Replace push button labels
Item #2. - IR#0004B Maintenance Rack Ratcliff S/N K1574
A. Replace safety latch (ordered 02-10-04) (2) B. Provide spare latches (6)
Materials: $ 325.00 Labor: $ 680.00 Travel: $ 100.00 Total: $1,105.00 This work is to be performed in a timely manner upon procurement of necessary materials from vendors. Lead time on material is 7 – 10 Days. The aforementioned pricing reflects the issuance of one purchase order to perform the entire work scope. If you choose to change the work scope, a revised quotation will follow to accommodate the changes. All work to be performed during normal working hours, in a reasonably clear area, by our own licensed electricians and servicemen.
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This price does not include a manlift/forklift to perform the repairs. If a manlift/forklift is required and not available on site, we will provide one to be billed at an additional cost. Freight will be billed at cost. Piquette and Howard reserves the right to determine whether or not a customer-supplied manlift is adequate to perform the work scope. This insures safe and efficient working conditions. The price quoted is firm for thirty (30) days and does not reflect sales taxes. If the project is tax exempt, a tax exempt certificate must accompany and purchase order. If the tax is applicable, it will be added to and made part of the contract amount. Terms are net thirty (30) days; subject to credit approval. If you should have any questions or require additional information, please do not hesitate to contact us. Regards, Dale Purdy Service Manager/Crane and Hoist Division SAMPLE
IR # A
OVERHEAD CRANES
CRANE INSPECTION AND CHECKLISTMEETS ANSI B30-2.0
ANDO.S.H.A. SECTION 1910.179
COMPANY NAME DATE
STREET ADDRESS JOB # P.O. #
CITY/TOWN STATE ZIP
CONTACT PERSON PHONE #
MANUFACTURER LOCATION CUST. I.D. #
COMMENTS:
Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
CRANE IDENTIFICATION
CAPACITY: MAIN HOIST CAPACITY: AUXILIARY HOIST CAPACITY: BRIDGE
SPAN BRIDGE TYPE: HOIST TYPE:
TOP RUNNING UNDERHUNG GANTRY TOP RUNNING UNDERHUNG
SERIAL NUMBER / BRIDGE SERIAL NUMBER / M/H SERIAL NUMBER / A/H
POWER SUPPLY: A.C. VOLTS D.C. VOLTS CONTROL VOLTAGE LIFT
ACCESS TO EQUIPMENT LOAD TEST MPT
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CRANE SURVEY CHECKLISTTROLLEYSECTION
Check Column
CAB-FESTOONCONDUCTORS
Check Column
GO
OD
DE
FE
CT
IVE
GO
OD
DE
FE
CT
IVE
COMMENTS COMMENTS
Driver wheelsIdler wheelsAxles – CouplingsShaftsAxle pinionMotorSlip ringsBrushesBrushholderBrakesGearcaseControllersResistorsSoft StartFreq driveContact tipsPush Button Station: Type Hubbel (Small gear case)CasePush ButtonsLabelsPendant SupportStrain chainNo. buttonsPendant CordCord connectorsOn Off switchLightSelector switchRadioBalancerCord ReelRadio Control: TypeTransmitterReceiverOperation
Cab Section:Bridge ControlMain hoist controlAux. hoist control#1 trolley control#2 trolley controlBridge brake pedalGlassLightStart stop stationMain line disconnectMain line contactorTransformerCleanliness
Festoon Section:TrackFlat cableRound cableFestoon trolleysHangersHanger supportsEnd stops TaglineCable connectorsControl trolleyTow trolleyTiller rope – Tag LineTow bar
Conductor Section:Runway conductorsRunway collectorsRunway splice coversRunway end capsRunway power feedsRunway collector shoesBridge conductorsBridge collectorsBridge splice coversBridge end capsBridge power feedsBridge collector shoes
A
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CRANE SURVEY CHECKLISTBRIDGESECTION
Check Column
HOISTSECTION
Check Column
GO
OD
DE
FE
CT
IVE
GO
OD
DE
FE
CT
IVE
COMMENTS COMMENTS
AlignmentGirdersRailsWalks - LaddersEnd trucksDriver wheelsIdler wheelsRail SweepsBumpersAxles-CouplingsShafts/BearingsAxle pinionsKeys-KeywaysBridge gear boxBrakes MotorSlip ringsBrushesBrush holdersResistorsSoft startFreq. driveMotor controllersContact tipsRunwayJ-Bolts – clipsLightsHorn or bellLubricationCapacity markings
GO
OD
DE
FE
CT
IVE
MAIN AUX
Load BlockLoad HookSheavesSafety latchesWire ropeRope anchorsRope GuideReavingDrumGear Boxes (2)MotorBrushesBrush holdersSlip ringsResistorsFreq. DriveMotor ControllerContact TipsElect. BrakeLoad brakeGeared limitPaddle limitLubricationOil leaksCapacity markings
A
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HAND CHAIN FALL INSPECTION REPORTSCUSTOMER DATE CUSTOMER P.O. JOB NUMBER
ADDRESS CITY STATE ZIP
CONTACT MANUFACTURER MODEL NO. SERIAL NO. CUSTOMER I.D. NO.
LOCATION ACCESS CAPACITY LIFT
MOUNTING LOAD TEST MPT CNTRL VOLT. VOLTAGE PHASE
DESCRIPTION GOOD DEFECTIVE COMMENTS
COMMENTS:
Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
IR # B
Hand Wheel CoverHand WheelHand ChainRatchetBrake DiscPawlPawl SpringDrive SpindleGear CoverGearsLoad WheelLoad ChainChain GuidesDead End Stud & LinkLoad Wheel GantryLoad HookTop Hook Safety LatchLubricationTrolleyTrolley lugsCapacity Markings
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ELECTRIC CHAIN HOIST INSPECTION REPORTSCUSTOMER DATE CUSTOMER P.O. JOB NUMBER
ADDRESS CITY STATE ZIP
CONTACT MANUFACTURER MODEL NO. SERIAL NO. CUSTOMER I.D. NO.
LOCATION ACCESS CAPACITY LIFT
MOUNTING LOAD TEST MPT CNTRL VOLT. VOLTAGE PHASE
DESCRIPTION GOOD DEFECTIVE COMMENTS
COMMENTS:
Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
IR # C
Chain Chain guide/ContainerLift wheelLoad wheelLoad hook/Block Top hook – LugSafety latchHoist elec. brakeHoist load brakeTransformerPaddle limit clutchGeared limitCentrifical switchCapacitorsContactorsContact tipsHoist motorCollectorsPower cordCord reelPendant cordPushbutton: type Gear caseTrolley motorTrolley controlTrolley brakeTrolley wheelsTrolley lugsBridge motor JibBridge control BracingBridge brake CapacityBridge wheels
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222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
COMPANY NAME _____________________________________________________
ADDRESS ___________________________________________________________
CITY & STATE _______________________________________________________
CONTACT ___________________________________________________________
SURVEY BY _________________________________________________________
DATE _______________________________________________________________
JOB# _____________________________ P.O. _____________________________
CHAIN/SLING INSPECTION SHEET
LOCATION MANUFACTURER SERIAL NO. TYPE SIZE REACH
CONDITION
O.K
.
Rem
oved
from
se
rvic
e
Hoo
kO
peni
ng
Mis
sing
Tag(
s)
MP
T
COMMENTS
1
2
3
4
5
6
7
8
9
Serviceman Signature ____________________________________________________
Customer Signature ______________________________________________________________
Customer Print Name ____________________________________________________________
CS #
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ELECTRIC CABLE HOIST INSPECTION REPORTSCUSTOMER DATE CUSTOMER P.O. JOB NUMBER
ADDRESS CITY STATE ZIP
CONTACT MANUFACTURER MODEL NO. SERIAL NO. CUSTOMER I.D. NO.
LOCATION ACCESS CAPACITY LIFT
MOUNTING LOAD TEST MPT CNTRL VOLT. VOLTAGE PHASE
DESCRIPTION GOOD DEFECTIVE COMMENTS
COMMENTS:
Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
IR # D
Load CableRope GuideDrumSheaveLoad HookSafety LatchHoist Electric BrakeHoist Mechanical BrakeTransformerPaddle LimitGeared LimitCentrifical Switch VFD DriveCapacitorsContact TipsHoist MotorCollectorsPower CordCord ReelPendant Cord Trans CasePushbutton: type RadioGear CaseTrolley Motor Tractor Drv.Trolley Control Tractor Drv.Trolley Brake Tractor Gear BoxTrolley WheelsTrolley lugsBridge Motor MonorailBridge Control Elec. SwitchBridge Brake Manual SwitchBridge Wheels Cap/Warning tags
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CUSTOMER DATE CUSTOMER P.O. JOB NUMBER
ADDRESS CITY STATE ZIP
CONTACT MANUFACTURER MODEL NO. SERIAL NO. CUSTOMER I.D. NO.
LOCATION ACCESS CAPACITY LIFT
MOUNTING LOAD TEST MPT CNTRL VOLT. VOLTAGE PHASE
DESCRIPTION GOOD DEFECTIVE COMMENTS
COMMENTS:
Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
IR # E
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CHARGING BUCKET
Lifting Eye/Bale
Support Arm
Cover
Cover Handle
Cover Hinge
Cover Latch
Bottom Door Arms
Bottom Door Hinge
Outside Bottom Flange
Support BoltsBolt on Exhaust Cover
Capacity Markings
External Welds/Misc.
CUSTOMER DATE CUSTOMER P.O. JOB NUMBER
ADDRESS CITY STATE ZIP
CONTACT MANUFACTURER MODEL NO. SERIAL NO. CUSTOMER I.D. NO.
LOCATION ACCESS CAPACITY LIFT
MOUNTING LOAD TEST MPT CONTROL VOLT. VOLTAGE PHASE
DESCRIPTION GOOD DEFECTIVE COMMENTS
COMMENTS:
Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
59 Ames StreetLawrence, Massachusetts 01841Tel: (978) 685-6145Fax: (978) 685-7936
IR # F
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PNEUMATIC CHAIN HOISTCUSTOMER DATE CUSTOMER P.O. JOB NUMBER
ADDRESS CITY STATE ZIP
CONTACT MANUFACTURER MODEL NO. SERIAL NO. CUSTOMER I.D. NO.
LOCATION ACCESS CAPACITY LIFT
MOUNTING LOAD TEST MPT PNEUMATIC
DESCRIPTION GOOD DEFECTIVE COMMENTS
COMMENTS:Copy of Report Issued Equipment left in Service Removed from service, locked out and tagged out, owner assumed responsibility
DATE:Piquette & Howard Serviceman (Signature)
DATE:Piquette & Howard Serviceman (Print)
DATE:CUSTOMER ACCEPTANCE (Signature)
DATE:CUSTOMER (Print)
222 Plaistow RoadPlaistow, NH 03865Tel: (603) 382-3182Fax: (603) 382-3582
WARREN BUSINESS GRAPHICS, INC. WALTHAM, MA 02451 • (781) 647-7760
IR # G
Load ChainChain Guide/ContainerLift Wheel/Load WheelLoad Hook/BlockTop Hook/LugLatchesHoist BrakePaddle Limit/Valve BodyHoist Air MotorAir Hose/FestoonRegulator/OilerAir Shutoff/DisconnectPendant/Rope ControlGearcaseTrolley Wheels/FrameRunway/SplicesEnd Trucks/Bridge WheelsEndstopsHangers, Support StructureCapacity/Warning TagBracingJib Base/Mast/BoomHead Rollers/Stops/HingesBase/AnchorsMonorail/Hanger Supports
G Pneumatic Chain Hoist Inspection Rpt_Hand Chain Fall Insp Rpt 7/2/14 1:24 PM Page 1
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