TECHNICAL SERVICES INSPECTION & CORROSION PROCEDURES

MAN LIFT INSPECTION FORM FORM:I- MH-1

Operations Integrity Management Systems
(OIMS)

TECHNICAL SERVICES/DEPARTAMENT-INSPECTION & CORROSION Instructivo: Inst-MH-1

Subject: Man lift inspection Form Hosting Procedure (Personel Lifthing Reference Code
Number: ASME B30.23
Systems). FORM (Mechanical Hosting) Code Number Form: MH-1
Fecha de Emisión: Noviembre de 2014 Rev N°: 0 Page N°: 1 of 2

DESCRIPTION AND INSTRUCTIONS OF MANLIFT INSPECTION FORM .

(CERTIFICATE - PERSONEL LIFTHING SYSTEMS)
NOTE: READ the follow instructions for completing the form MH-1.
1.- CERTIFICATE NUMBER: Clearly provide the consecutive number of the certificate of inspection for
traceability..
2.-CONTRACTOR: Provide Name Contractor and/o Company Responsible of carrying out the activity
and implement this procedure
3.- Insp. Date: Clearly provide the date the inspection was conducted.
4.- Insp. Location: Provide physical location where the inspection was carried out.
5.- Manufacturer: Provide the name of the manufacturer of the equiptment to which you performs the
inspection.
6.- Serial: Indicate what the serial identification that shows identification the nameplate, this serial must be
traceable with the manufacturer.
7.- Model: Specific type of unit equipment or machines, industrial trademark, which belongs indicad, on
the nameplate.
8.-Capacity: Check the load capacity of the Equipment in the Nameplate. Also to check in the panel while
being performed the load test and proceed to fill and register in the box the result that it show in the
panel..
9.-Work Hours: Indicate the number of hours of work that shows the operating hours counter that
equipment has been working.
10.-Certify by: Check if the machine has a certifícate, and provide the name of the company or
government entity issuing the certificate.
11.-Expire day: Provide the date of expiry of the certificate issued by an external Company or third party
or government entity.
12.-Inspector: Put name of the responsable person for to do all work associated with the inspection, and
which has a certification by International Recognition preferably by CRANE INSPECTION &
CERTIFICATION BUREAU – CICB and must be training of INTERNATIONAL CERTIFICATION OF
INSPECTORS AND MOBILE CRANE AND HOIST DEVICES and experience no minor to 3 years in
inspection of lifting equipment.
13.-Next Inspection Day: Provide next inspection date, according with inspection interval or preset
interval conform to their use, repair or alteration. All component of equipment must be undergo periodic
inspection by an inspector (12) at intervals not exceeding 12 months.
14.-DESCRIPTIÓN: It should give a brief description of the characteristics of the equipment.
15.- Inspection After Certification: Must be indicated if the inspection was done after certification YES or
NOT.
16.-Code Reference: It’s the reference code for inspection of the ítem listed below.
17.-Inspection Result: Indicates the section of the certificate where it be reflected in each space the
inspection result found.
18.-Item For Inspection: Parts List of the equipment, that require to be inspected during the application
of this procedure.
19.-Condition: Result of the condition found during the inspection. Sat o Unsat.
20.-SAT: Satisfactory result with the requirements of that standard CODE REFERENCE (Item 16).
 TECHNICAL SERVICES INSPECTION & CORROSION PROCEDURES
MAN LIFT INSPECTION FORM FORM:I- MH-1
Operations Integrity Management Systems
(OIMS)

TECHNICAL SERVICES/DEPARTAMENT-INSPECTION & CORROSION Instructivo: Inst-MH-1

Subject: Man lift inspection Form Hosting Procedure (Personel Lifthing Reference Code
Number: ASME B30.23
Systems). FORM (Mechanical Hosting) Code Number Form: MH-1
Fecha de Emisión: Noviembre de 2014 Rev N°: 0 Page N°: 2 of 2

21.- UNSAT: Non-Satisfactory result with the requirements of that standard CODE REFERENCE (Item
16).
22.- COMMENTS: Provide any relevant comments associated with the item inspected.
23.- Equipment Certification is Update?: SAT OR UNSAT, Provide the certificate number of the load
test equipment.
24.- Name Plate: SAT OR UNSAT, The nameplate must be clearly legible, with all the technical
characteristics relating to the Equipment, especially serial, Load capacity, manufacturer, reference
code, manufacture year and other data of interest for this inspection.
25.- The secondary brake governor: SAT OR UNSAT, Must be tested before each day's use. Where
testing is not feasible, a visual inspection of the brake shall be made instead to ensure that it is free to
operate.
26.- Control Panel (MANLIFT): SAT OR UNSAT, Provide information if it has been tested for verify if
found in optimum condition and the operating is safe.
27.-Control Panel (BASKET): SAT OR UNSAT, Provide information if it has been tested for verify if
found in optimum condition and the operating is safe.
28.-Emergency terminal stopping and speed limiting devices: SAT OR UNSAT
29.-Leveling Zone and Speed indicator: SAT OR UNSAT
30.-Governors: SAT OR UNSAT
31.-Safe Alarm: SAT OR UNSAT
32.-Stand-by Power Operation: SAT OR UNSAT
33.-Fire extinguisher: SAT OR UNSAT
34.-Load Supporting Welds/Bolts: SAT OR UNSAT
35.-Load Supporting Members: SAT OR UNSAT
36.-Barrier From Toe Board To Intermediate Rail: SAT OR UNSAT
37.-Structure Basket: SAT OR UNSAT
38.-Fall Protection Device Anchorage Points: SAT OR UNSAT
39.-Gate Locking Mechanisms: SAT OR UNSAT
40.-Platform Flooring: SAT OR UNSAT
41.-Lifting Arm System: SAT OR UNSAT
42.-Suspension Attachments Points: SAT OR UNSAT
43.-Stand-by Power Operation: SAT OR UNSAT
44.-Load test & drop test with load: SAT OR UNSAT. This shall include the load at which the test is
performed lifting equipment. It can’t be greater than 110% from the nominal load.
45.-Structure Lifting Arm: SAT OR UNSAT
46.- Telescopic Arm System: SAT OR UNSAT
47.-Arm Rotation System: SAT OR UNSAT
 TECHNICAL SERVICES INSPECTION & CORROSION PROCEDURES
MAN LIFT INSPECTION FORM FORM:I- MH-1
Operations Integrity Management Systems
(OIMS)

TECHNICAL SERVICES/DEPARTAMENT-INSPECTION & CORROSION Instructivo: Inst-MH-1

Subject: Man lift inspection Form Hosting Procedure (Personel Lifthing Reference Code
Number: ASME B30.23
Systems). FORM (Mechanical Hosting) Code Number Form: MH-1
Fecha de Emisión: Noviembre de 2014 Rev N°: 0 Page N°: 3 of 2

48.- Pin/Ears/Bolt-Ups/Eyes (circle): SAT OR UNSAT

49.- Wire Rope/Chain/Rigid Leg (circle): SAT OR UNSAT
50.-Master Link: SAT OR UNSAT
51.-Hoses and Conex. Hydraulics Systems: SAT OR UNSAT
52.-Brake: SAT OR UNSAT
53.-Oil Buffers: SAT OR UNSAT
54.-Direction: SAT OR UNSAT
55.-System Inclination Basket: SAT OR UNSAT
56.- System Turn Basket: SAT OR UNSAT
57.-Overhead Protection: SAT OR UNSAT
58.-Flotation: SAT OR UNSAT
59.-Platform Controls Special: SAT OR UNSAT
60.-Tires: SAT OR UNSAT
61.-Load test & drop test with load: SAT OR UNSAT
62.-Observed Conditions: You must indicate if any relevant special condition that threatens the integrity
and safety of the equipment.

63.-Corrective Actions: You must indicate if there are any immediate corrective action to apply.
64.-Final Condition: You must indicate if is certified or not to perform the activity of lifting people
according to their capacity and reference code.
65.-CONTRACTOR: This space is for the signature of the representative of the contractor which is
performing this format.
66.-REVIEWED BY: This space is for the signature of the representative of the Staatsolie which to
reviewed the activity.
67.-APPROVED: This space is for the signature of the representative Technical Service which is
approved & certified the equipment.
NOTES:
A.- If an item does not apply, do not leave empty spaces, put only applies if it is not the case.