Installation Instructions
Model XX0355
ECN2579
Page 16 of 16
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 for loose, missing, worn, or broken fasteners.
High
Inspect metal parts for structural and fi nish damage.
Medium
Inspect surfacing to insure proper depth and distribution.
High
Inspect footing to insure support is secure and footing is not damaged.
Low
