Page 18 of 20 BM15101 Molift NOMAD English - Rev. M 23-08-2013
Checklist for periodic inspection
Lifter serial no.: .............................. .................................. Other ID. no. (if any): ........................................................
Client:............................................... .................................. ....................... .....................................................................
Inspection carried out by: (Block capitals) ....................... ...............from.....................................................................
Molift certification no. for inspector/repairer (if any): ... ....................... .....................................................................
The equipment has been tested and is in full working order Yes No
Place: ......................................Date: ................. Signature:....................... .....................................................................
Checklist for periodic inspection of Molift Nomad
Revision A – 10/2007
COMPULSORY SAFETY CHECK (annual):
OK Fault Corrected Visual inspection
Whole lifter checked for damage, cracks and deformation and found to
be in good order. (Especially lifting hooks, lifting belt with hooks,
screw piece and all cables).
Lifter has been correctly assembled and has no loose parts.
Accessories have been checked. See separate form for sling. Battery
charger is an accessory.
List the accessories checked:…………………….………………
Function checks
Emergency stop and manual control have been checked and are in
working order.
The lifter has been tested on the installation (preferably under load)
and runs easily throughout the installation and the end stops are in
order.
The lifter has been fully raised and lowered (preferably under load)
and moves evenly, stopping in the up and down positions by means of
limit switches.
Servicing required
Servicing unnecessary because the servicing lamp is on green and the
lifter is under 5 years old.
Completed Compulsory in case of faults under one of the above points:
The lifter has been removed from service and clearly marked "OUT OF ORDER".
Certified personnel have been summoned to carry out repairs and servicing.
Name /Tel./ Fax:…………………………………………………………………
Completed Compulsory where lifter has been checked and approved:
The lifter has passed the safety check and been affixed with the Molift safety check
label, duly dated and signed.
The ticked and signed checklist has been passed to the client.
.
Comments on faults and repairs: ............................ .............................................................................
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