Product number(s)* A
Serial number(s)* B
WLL* C
Year of manufacture* D
Name of user
Date of purchase
Date of first use
Periodic Examination and Repair History
Date
Inspected by
Pass/Fail
Comments
Equipment Record
Product number(s)*
(A)
Serial Number(s)*
(B)
Year of manufacture* (C)
Name of user
Date of purchase
Date of first use
Periodic Examination and Repair History
Date
Inspected by
Pass/Fail
Comments
*Insert this data into
table below
* Insert data from serial
numbers found on
product into table below
INSPECTION RECORD
INSPECTION
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