INSPECTION CHECKLIST FOR BOOM LIFTER (UGM-08)
METRO PROJECT CHECKLIST PACKAGE CITY
Customer Name: M/S VIKAS CRANE SERVICE Date of Inspection: 04-Apr-2024
Site Address: MAHSR C4 SECTION IV CH 322 KUKARWADA BHARUCH
Call Reference No: Start Time: 12:00 End Time: 1:00
Certificate Date: 04-Apr-2024 Certificate No.: Invoice No.:
Certificate will not be issued if the Safety Parameters Point/s mentioned in BOLD are not observed satisfactory.
(A) Identification/ Description
1.1 Name of Manufacturer JLG LIFT 1.5 Lifting Height -
1.2 Boom Serial Number 1.6 Manually/Remote
0300107981 ( QR CODE: QRA00151 ) Manually
1.3 Model 800S 1.7 Date of Manufacturing 2020
1.4 Boom Length 80 Fit
( B ) Last inspection Details
3.1 Date of last Inspection/Certification 04-Apr-2024 3.3 Certificate number First time inspection
3.2 Inspection By Uniquo
(C) Inspection Checkpoints Observations (C) Inspection Checkpoints Observations
4.1 Wheels and Tyres OK 4.7.1 Cylinders/Rods OK
4.2 Lights OK 4.7.2 Hoses/Lines/Fittings OK
4.3 Engine/Engine compartment OK 4.8 Fluids Ok
4.3.1 Cables/Wires OK 4.8.1 Engine oil OK
4.3.2 Belts/Hoses OK 4.8.2 Hydraulic oil OK
4.3.2 Any leakage OK 4.9 Tilt Sensor (if any) OK
4.4 Operator Procedure Sticker OK 4.10 Counter Weights OK
4.5 Instruments/Gauges OK 4.11 Man Cage Ok
4.6 Safe Working Load (Display) OK 4.11.1 Bolts& Nuts OK
4.7 Hydraulics OK 4.11.2 Foot Pedal (Damage) OK
(D) Safety
(D1) Equipment Safety
5.1 External Panel (All Switches) OK 5.5 Primary/Secondary Boom OK
5.2 Emergency Stop Function Yes 5.6 Brake OK
5.3 Forward/Backward Movement OK 5.7 Buzzer Yes
5.4 Slewing condition OK 5.8 Telescopic OK
Office: G-103, Bhakti Park, Phase 2, Anand Nagar, Bhakti Park, Ghodbunder Road, Thane 400607
Email: uniquo@yahoo.com Mobile: 09321905149
Check list Sr. No. – UGM.08 (05/17)
INSPECTION CHECKLIST FOR BOOM LIFTER (UGM-08)
METRO PROJECT CHECKLIST PACKAGE CITY
(D2) Operation Safety
6.1 Check list Availability Yes 6.3 Safety Stickers are Fixed Yes
6.2 Operator Trained & Certified Ok
(D3) Workplace Safety
7.1 Work Permit in place Yes 7.2 Job Safe Plan in practice Yes
Any Other Important information not covered in check list:
Recommended SWL 227 kg
* Emergency not working
NOTE: NO DASH (-) IS ALLOWED.EITHER WRITE “NOT APPLICABLE/NOT AVAILABLE” WHERE NEEDED.
Result: Unfit For Use
(E) Name of 1 □
✔ Site In-charge /2 □Safety officer
Mr. Rakesh yadav 8417978100
1. Name______________________________________Mob: ______________________________
Email Id: ______________________________________Sign:______________________________
2. Name______________________________________Mob: ______________________________
Email Id: ______________________________________Sign:______________________________
(F) Operator Name_______________________ Mob: ______________ Sign: __________________
(G) Certificate to be sent to
1. Name: _________________________________Email: __________________________________
(H) 1. Acceptance message to customer: 2. Call closure message to customer:
3. Certificate mailing message to customer:
Office: G-103, Bhakti Park, Phase 2, Anand Nagar, Bhakti Park, Ghodbunder Road, Thane 400607
Email: uniquo@yahoo.com Mobile: 09321905149
Check list Sr. No. – UGM.08 (05/17)
