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ANNUAL OVERHEAD

K�::�ECTION SERVICES IN

� RANE IN s p E CTI ON

www.kempcoinspections.com

4747 Gulf Freeway

Houston, TX 77023

713-926-1005 off.

713-926-6033 fax

Tulsa, OK 918-200-5511

Corpus Christi, TX 361-443-7757

CUSTOMER: ____________________ LOCATION __________________ _

EQ#: I MAKE: MODEL:

PO#: I W/0:

IAIR/ELECTRIC/CHAIN:

A U AA - cceo a e t bl - nacceota e uu bl

DD 1. Emergency Power Off (Marked)

DD 2. Master I.D. Switch

DD 3. Controllers / Control Buttons

DD 4. Warning Signs & Alarms

DD 5. Hook / Safety Latch / Dye Test

DD 6. Crane Structure/ Rail

DD 7. Ladders & Cages

DD 8. Walkways / Guardrails

DD 9. Beam Capacity (Marked)

DD 10. Braking System

DD 11. Hoist System

DD 12.Sheaves

DD 13. Full Operational Functions

DD

DD Cable

DD 14. Load Line

DD Chain

DD 15. Load Test

I SERIAL#: I DATE OF INSPECTION:

I INSPECTED BY: I Cl PASS D FAIL

C ommen s

COMMENTS/APPEARANCE:-----------------------------------------

Signature Showing Repairs Complete _______________________ Date:-----------=�.,.,.., KISS94218

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Do Not Copy - Sample

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Do Not Copy - Sample

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