Annual Inspection Report
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5Annual Inspection Report
Owner: _________________________________________ Date: ___________________
Make: _____________________________ Model: ________ S/N: _______ Year: _____
Engine
1. Does the engine start and run smoothly?
Yes____ No____
2. Is oil pressure adequate?
Yes____ No____
3. Is fuel pressure adequate?
Yes____ No____
4. Are fan belts properly adjusted?
Yes____ No____
5. Is the radiator core clean?
Yes____ No____
6. Is there evidence of oil leaks?
Yes____ No____
7. Is engine clutch properly adjusted?
Yes____ No____
Drum Shaft Assembly
1. Is there excessive wear on brake and clutch system parts, linings,
pawls, and ratchets?
Yes____ No____
2. Are friction flanges scored?
Yes____ No____
3. Are drum clutches holding properly?
Yes____ No____
4. Are drum sleeve bearings properly adjusted?
Yes____ No____
5. Are drum brakes holding properly?
Yes____ No____
6. Are all clutch control parts properly lubricated?
Yes____ No____
Independent Boom Hoist
1. Are brake linings in good condition?
Yes____ No____
2. Is boom hoist operating satisfactorily?
Yes____ No____
3. Does friction brake operate satisfactorily?
Yes____ No____
4. Does ratchet brake operate satisfactorily?
Yes____ No____
5. Is hoist rope properly wound on drum?
Yes____ No____
Travel Base
1. Are the teeth of ring gear in good condition?
Yes____ No____
2. Is the roller path on ring gear in good condition?
Yes____ No____
3. Are the travel gears inside the travel base in good condition?
Yes____ No____
4. Does the machine steer properly?
Yes____ No____
5. Does the band type travel brake hold satisfactorily?
Yes____ No____
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Parent category: Medical