Test Report
Of a periodic /special examination
The lifting platform underwent an examination regarding operational readiness on
The following/no*) faults found.
Test scope
Still pending
Partial tests
There are no*) reasons against continued operation, retesting is not*) required.
The technical expert/surveyor
(Place ,date) (Signature)
Name and address
(in block letters )
Job title
Employed at
Operator or Representative
Deficiencies noted
(Place ,date) (Signature)
Deficiencies fixed
(Place ,date) (Signature)
Retesting
The lifting platform underwent retesting on
The deficiencies which were pointed out in the examination have not*) been fixed yet.
There are no*) reasons against continued operation, retesting is not*) required.
The technical expert/surveyor
(Place ,date) (Signature)
Name and address
(in block letters)
Job title
Employed at
1
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