Alsina ALSIPERCHA - Inspection and Maintenance Records; Device Identification and Periodic Checks

6490009ENLZ / 6790009ENLZ
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18
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Inspection and maintenance Alsipercha system
A DEVICE IDENTIFICATION SHEET
(A) Distributor / Reseller / Details
(B) Manufacturer
Encofrados J. Alsina S.A.
Pol. Ind. Pla d’en Coll
Camí de la Font Freda, 1
08110 - Montcada i Reixac (Barcelona - Spain)
(C) Product (type, model, code)
(D) User (company, name and address)
(E) Serial number / batch
(F) Year of manufacturer
(G) Purchase date
(H) Date of fi rst use
(M) Notifi ed Body that performed the CE certifi cation / check
DEKRA EXAM GmbH
Dinnendahlstrasse 9 - D-44809 BOCHUM
Phone : +49 (0) 234 3696 105
Website : www.dekra-exam.de
B DEVICE PERIODIC CHECK SHEET
No. (O) Date (P) Reason for check
(Q) Name and signature of the per-
son responsible for checking
(R) Notes (defects found or
other relevant information)
(S) Check results
(T) Date
of next
check
1
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Periodic check
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Additional check
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Device fi t for use
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Device unfi t for use
□
Device to be checked
2
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
3
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
4
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
5
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
6
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
7
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
8
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
9
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked
10
□
Periodic check
□
Additional check
□
Device fi t for use
□
Device unfi t for use
□
Device to be checked