Fabric/wire & Cordage/linear Measure Test Form
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1JURISDICTION_______________________________
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FABRIC/WIRE & CORDAGE/LINEAR MEASURE TEST FORM
Date
Type of Business
Phone
Zip Code
Firm's Name
Address
City
Reinspection
Condition of Seal (as found)
Broken
Intact
None/New
INSPECTION CHECKLIST
PERFORMANCE TEST
Meets
Does Not
TEST IN
ERROR IN
N/A
Require-
Meet
ments
CM M IN FT YDS
CM M IN FT YDS
Require-
ments
SPECIFICATIONS
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Units
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Indicating Elements
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Money Computations
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Zero Indication
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Sensitiveness
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Slippage
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Accessibility
MARKING REQUIREMENTS
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Limitation of Use
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Operating Instructions
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Indications
USER REQUIREMENTS
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Installation
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Limitation of Use
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Return to Zero
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Operation of Device
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HANDBOOK 44 SECTIONS
Cleanliness
Fabric
5.50.
MEETS ALL REQUIREMENTS
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____
Wire- and Cordage
5.51.
Linear
5.52.
REMARKS:
ACTION TAKEN
Sealed
Rejected for Repair
Condemned for Use Until Repaired
Not Tested (see remarks)
_________________________________________
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Weights and Measures Inspector
Owner or User
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