19
294000.10040 Rev A
LOLER: Thorough Examination Report
Lifting Operations and Lifting Equipment Regulations 1998 Schedule 1
Client Name & Address ______________________________________________________________
_______________________________________ Tel ______________________________________
Address of Examination _____________________________________________________________
Model ____________________ Serial No. ___________________ Date of Manu. ______________
Date of last Examination ________________ Safe Working Load ____________________________
Commissioning Examination
❏
Yes
❏
No
Safe to Operate
❏
Yes
❏
No
❏
N/A
Periodic Examination
❏
Yes
❏
No
Interval of Examination
❏
6 Months
❏
12 Months
❏
Examination Scheme
❏
Exceptional
Safe to Operate
❏
Yes
❏
No
❏
N/A
Defective Parts (Immediate Attention):
Defects requiring rectification at a later date:
Part Number
Description
Defect
Action Taken
Part Number
Description
Defect
Action Taken
Latest Date
Next examination due date ___________________________
Load test conducted according to
❏
BS 5827
❏
BS EN ISO 10535
❏
Other (state) ______________
Thorough examination carried out (Date) _______________________
Name of Examiner ___________________________ Job Title _______________________________
On behalf of (Company/Organisation) ___________________________________________________
Address __________________________________________________________________________
________________________________________________________
Signed _________________________
Signed on behalf ________________________________
Name & address ________________________________
______________________________________________
______________________________________________
______________________________________
Date of Report ___________________
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