BM04101 Molift Quick Raiser English - Rev F/ 09/2012 Page 18 of 20
Checklist for periodic inspection
Lifter serial no.: ............................. .................................Other ID. no. (if any): .....................................................
Client:............................................. ................................. ..................... ..................................................................
Inspection carried out by: (Block capitals) ...................... ............. from..................................................................
Molift certification no. (if any) for inspector/repairer: .... ..................... ..................................................................
The equipment has been tested and is in full working order Yes No
Place: .................................... Date: ................ Signature: ..................... ..................................................................
Checklist for periodic inspection of Molift Personal Lifters
Molift Quick Raiser 1, 2 and 2+
Revision C – 12/2008
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 raising arm, trolley with bolt, column, chassis,
wheels and all cables).
Lifter has been correctly assembled and no parts are missing.
(Especially column attachment, knee supports and raising arm).
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 rolled over the floor (preferably under load) and moves
easily and steadily.
Leg extender mechanism (Quick Raiser 2 and 2+) has been fully extended
and retracted (preferably under load), and moves evenly and without noise
(stops in correct positions).
The lifter has been fully raised and lowered (preferably under load) and
moves evenly and without noise.
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 and a copy sent to your
Molift dealer.
.
Comments on faults and repairs:............................. .................... ............................................................
................................................... ............................. .................... ............................................................
................................................... ............................. .................... ............................................................
................................................... ............................. .................... ............................................................
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