Installation Instructions
Models XX0193 and XX0193S
ECN2716
Page 14 of 14
Inspection Form
• Be sure that you are using a copy of this Inspection Form and not your original.
• Use the Inspection Codes listed below and record condition of equipment at time of
examination on the Inspection Checklist.
• Document any item from the Inspection Checklist that will require maintenance along with
any corrective action on the Maintenance Schedule.
• Be sure to include appropriate dates and signatures on each section to properly document
maintenance procedure.
Preventive Maintenance
. . . for Safety's Sake!
Repairer: Name
(Please Print)
__________________________________ Signature:________________________________________ Date:___ /___
/___
MAINTENANCE SCHEDULE
Item in Question
Description of Problem
Corrective Action
Date
Inspector: Name
(Please Print)
__________________________________ Signature:_________________________________________ Date:___ /___ /___
Inspection Codes
P
= Pass
F
= Fail
NA
= Not Applicable
INSPECTION CHECKLIST
Frequency
Inspection
Code Date
Date Repairs
Completed
Inspect plastic parts for damage.
Medium
Inspect spring connections for tightness.
High
Inspect metal parts for structural and fi nish damage.
Medium
Inspect for loose, missing, worn, or broken fasteners.
High
Inspect footing to insure support is secure and footing is not damaged.
Low
Inspect surfacing to insure proper depth and distribution.
High
