Total Sheet 20

Vendor’s name : MHE-Demag (M) SDN BHD

: Nghi Son Refinery and Petrochemical LLC.
Company 's name : JGCS Consortium
: SK Engineering & Construction Co., Ltd.
Plant Location : Nghi Son, Vietnam
Project name : NSRP Complex Project
P / Order No. : 0-6495-PS2155-501-A100
Overhead Crane for Recycle Gas Compressor and H2 Makeup
Equipment/Material name : Compressor
Item number : 011-CR-001 & 014-CR-001
Document title : Inspection and Test Procedure

PROJECT (JOB No.: 0-6495-20)

DOCUMENT CLASS: X
ISSUE PURPOSE: FR
RESULT CODE: A, B, R, F ( B )
NEXT STATUS: FA, FR, FI, FC, AB ( FR )
RESUBMISSION DATE: ( asap )
RESPONSIBLE DEPT./PERSON: ( QC/SCB )
Review Date: ( 6th Mar. '15 )
A: Approved without Comment; B: Approved with Minor Comment
R: Not Approved; F: Not Subject to Review
Approval or review hereunder shall not be construed to relieve Vendor/ Subcontractor of his
responsibilities and liability under the Contract

Purchaser ORIG. PURCHASE ORDER NO. SERIAL REV.

DOC. No.
V S2155-501-A- 604 1

1 23 FEB. 2015 FOR REVIEW KAMIL AKMAL KELVIN

0 23 DEC. 2014 FOR REVIEW KAMIL AKMAL KELVIN
Rev. No. Date Description Prep'd Chk'd App'd
Vendor's Name MHE-Demag (M) SDN BHD

Vendor Logo & Name

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`
INSPECTION & TEST PROCEDURE

No. Contents Pages

1. Material Inspection 2

2. Welding Inspection 2

3. Painting Inspection 2

4. Dimensional and Assembly Check 2

5. Insulation Resistance Check 3

6. Sequence Check 3

7. Functional Test Without Load 3

8. Load Test and Overload Test 4

9. Packing Inspection 5

10. Attachment of QC Forms 5

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1. Material Identification

1.1 Raw material ie. steel plates shall be checked against the mill certificates. The surface, dimension and
characteristic of steel plates shall be checked for conformity.

1.2 The hook, wire rope, hoist and drive motors shall be checked against test certificates.

Acceptance Criteria

i. QC Sheet : QM.PD.QC.01.00

2. Welding Inspection

2.1 All welds shall be visually inspected in accordance with AWS D1.1 or equivalent. A weld shall be
acceptable by visual inspection if it shows that,
a) The weld has no crack.
b) Welds shall be free from overlap.
c) There are no arc strikes on any base metal outside of the permanent weld area.
e) Welds shall be of sufficient size (i.e. weld leg, throat, etc.) specified in the drawing.
f) No excessive undercut.

2.2 10% of the total length of the crane girder butt weldment shall be checked by radiographic examination.

2.3 10% of the total length of the crane girder fillet weldment shall be checked by magnetic
particle inspection.

Acceptance Criteria

i. AWS D1.1
ii. QC Sheet : QM.HC.QC.01.35

3. Painting Inspection

Total dry firm thickness shall be measured with an Elcometer. Painting activities shall be performed in
accordance with the surface preparation & painting procedure.

Acceptance Criteria

i. QC Sheet : QM.HC.QC.01.37

4. Dimensional and Assembly Check

The girders, crab/winch, shall be assembled separately at the workshop and the crane dimensions shall be
checked against the Approval Drawing / Manufacturing Drawing. Wire rope, hook, hoist and drive motor
shall be witnessed by SKC QC or should be submitted by QC report.

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The allowable tolerance (MHE-Demag Standard) for all the dimensions shall be as indicated in the individual
Q.C. Reports.

Acceptance Criteria

i. QC Sheet : QM.HC.QC.01.38
ii. QC Sheet : QM.HC.QC.01.40
iii. QC Sheet : QM.HC.QC.01.84
iv. QC Sheet : QM.HC.QC.01.16
v. QC Sheet : QM.HC.QC.01.17

5. Insulation Resistance Check

After the crane has been assembled, the insulation of the electrical system shall be tested. A voltage of
1000 VDC shall be used for testing. All 3 phases of each crane motion shall be tested. The insulation
resistance of the system tested shall not be less than 0.5-Megaohms

Acceptance Criteria

i. QC Sheet : QM.RE.QC.01.09

6. Sequence Check

Electrical sequence check shall be performed on the individual control panels upon completion of panel
wiring. Functional test for control, brake & limit switches shall be performed.

Acceptance Criteria

i. QC Sheet : QM.RE.QC.01.06

7. Functional Test Without Load

The functional and correct adjustment of brakes and limit switches shall be checked and tested to ensure
that primary safety and emergency systems are operating correctly. The correct operation of each motion
throughout its range of operation shall checked

a) Hoist unit - Lifting unit shall be tested by rotating the drum with the wire rope installed.

b) Cross travel motor – The crab will be placed on top of the crane girders. The wheel will then be moved
from one end of the girder to the other end.

c) Long travel motor – The crane will be set up on stands. The long travel motors will be activated. The test
will be considered successful if the wheel turn freely and no defects are found during testing.

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The test shall be considered successful if no cracks, permanent deformation, paint flaking or damage that
affected the function and safety of the crane is visible and no connection has been loosened or been
damaged.

Acceptance Criteria

i. QC Sheet : QM.RE.QC.01.10
ii. QC Sheet : QM.HC.QC.01.19
iii. QC Sheet : QM.HC.QC.01.20

8. Load and Overload Test

The test shall be considered as successful when cracks, permanent deformation, paint flaking or damage
that affect the function and safety of the crane are not observed and no connection has been loosen or been
damaged. The hooks shall be free to rotate 360angle when supporting rated load. The maximum stress in
the hook at its rated load shall not exceed 20% of the ultimate strength of the material.

8.1 Load Test with 100% Load

Load shall be placed stationary at mid-span of girder. The load so then lifted and the vertical
deflection of the crane girder is recorded. The vertical deflection must not does not exceed L/1000
of crane span.

The permissible deflection ≤ L/750, where L = girder span

The crane is rigidly support at both of the end carriages. The test load block will be used and place
in between of the bottom of 2 crane girders.

Acceptance Criteria

i. QC Sheet : QM.HC.QC.01.21
TCVN 4244 : 2005
BS 466
8.2 Load Test with 125% Load

The crane shall be tested such that the lifting unit, the crab and the crane as a whole are subject to
125% of their safe working load.

During the test(s) the crane motions shall be tested as follows:

a) Lifting units – The lifting unit drum(s) shall be rotated through one revolution such that all gear
teeth are tested under overload conditions.

b) Cross travel – The crab of the crane shall be moved 1 revolution of its travel wheel to ensure
that each gear tooth of the cross travel system is subjected to the overload condition.

Acceptance Criteria

i. QC Sheet : QM.HC.QC.01.21
TCVN 4244 : 2005
BS 466

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8.3 Dynamic Load Test with 110% load.

Dynamic test is done after load test with 125% load. This test will check the overall crane structure
and brakes.

During the test(s), trial load is lifted up and down at least 3 times and the structure on carrying load
must be checked.

Acceptance Criteria

ii. TCVN 4244:2005

BS 466
9. Packing Inspection

The packing inspection will be performed prior to shipment which in accordance to the packing procedure
and packing list.

Acceptance Criteria

i. Packing List

10. Attachment of QC Form Reports (This QC forms are MHE standard - No changes on this documents)

i. QC Sheet : QM.PD.QC.01.00
ii. QC Sheet : QM.HC.QC.01.35
iii. QC Sheet : QM.HC.QC.01.38
iv. QC Sheet : QM.HC.QC.01.40
v. QC Sheet : QM.RE.QC.01.10
vi. QC Sheet : QM.HC.QC.01.19
vii. QC Sheet : QM.HC.QC.01.20
viii. QC Sheet : QM.RE.QC.01.09
ix. QC Sheet : QM.RE.QC.01.06
x. QC Sheet : QM.HC.QC.01.37
xi. QC Sheet : QM.HC.QC.01.21
xii. QC Sheet : QM.HC.QC.01.16
xiii. QC Sheet : QM.HC.QC.01.17
xiv. QC Sheet : QM.HC.QC.01.84

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 DOC NO : QM.PD.QC.01.00

QC INSPECTION REPORT ISSUED BY :

Onn Kian Leong (on

behalf of Production)

TITLE : MATERIALS IDENTIFICATION APPROVED BY: J Moeller

EFFECTIVE DATE : 11.01.10 SUPERSEDES NO : PAGE 1 OF 1

3/1/2008

CLIENT/PROJECT : NETWORK NO :

MILL
MECHANICAL SURFACE
CERTIFICATE
No. DESCRIPTION QUANTITY MATERIAL SIZE HEAT NO. PROPERTIES CONDITION
VERIFIED? (Ref
VERIFIED? Grade A or B
No.)

REFERENCE:

Code Grade Min Yield Min Tensile Chemical Composition (% Max)

Manganese,
Strength Strength Carbon, C Silicon, Si Sulfur, S Phosphorus, P Nitrogen,N Copper,Cu
Mn
(N/mm2) (N/mm2)

S235JR* 235 360 0.17 - 1.4 0.035 0.035 0.012 0.55

EN 10025 S275JR* 275 410 0.21 - 1.5 0.035 0.035 0.012 0.55

S355JR* 355 470 0.24 0.55 1.6 0.035 0.035 0.012 0.55

ASTM A36 250 400 0.25 0.4 1.2 0.05 0.04 - -

JIS G 1301 SS 400 245 400 - - - 0.05 0.05 - -

BS 4360 43A* 275 430 0.25 0.5 1.6 0.05 0.05 - -

DIN 17100 ST52* 355 510 0.2 0.55 1.6 0.04 0.04 - -

* based on ladle Analysis

Name Signature/Date Designation or Company

Inspected by :

Approved by :

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 QM.HC.QC.01.
Form NO.:
35
QC inspection report
ISSUED BY: C L CHONG
WELD CHECK & N.D.T

EFFECTIVE DATE: 1/1/97 SUPERCEDES NO.:

APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

WELD MAP – DOUBLE GIRDER

VISUAL RT MT/DPI UT
LOCATION THICKNESS
BUTT FILLET BUTT BUTT FILLET BUTT FILLET

A) ACCEPTANCE CRITERIA : _______________

B) ATTACHMENTS : ________________

Name Signature/Date Designation or Company

Inspected by:

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IN AR 15
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 Form NO.: QM.HC.QC.01.38
QC inspection report
CRAB DIMENSIONAL CHECK ISSUED BY: Martin Yeo

EFFECTIVE DATE: 01/10/2008 SUPERSEDES NO.:

APPROVED BY: Kell M Niemann
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

ACCEPT/ ACCEPT/
REF TOLERANCE DESIGN MEASURED REF TOLERANCE DESIGN MEASURED
REJECT REJECT
TG3 +- 3 W3 +-3
TG4 +- 3 W4 +-3
D1 +-3 IE3 +-5
D2 +-3 IE4 +-5

REMARKS :
1) All dimensions in mm

Name Signature/Date Designation or Company

Inspected by:

D R A
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IN2-MAR 15
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 Form NO.: QM.HC.QC.01.40
QC inspection report
ISSUED BY: Martin Yeo
CRANE DIMENSIONAL CHECK

EFFECTIVE DATE: 01.10.2008 SUPERSEDES NO.:

APPROVED BY: Kell M Niemann
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

ACCEPT/ ACCEPT/
REF TOLERANCE DESIGN MEASURED REF TOLERANCE DESIGN MEASURED
REJECT REJECT
LR IE1 + - 20
LL IE2 + - 20
D1 TG1 +-4
D2 TG2 +-4
W1 TG3 +-4
W2 HA1 + - 50
CH +-8 HA2 + - 50

REMARKS :
1) All dimensions in mm 4) W1 & W2 – W < = 3000 = + - 3
2) LR & LL – Span < = 15000 = + - 2 W > 3000 = + - W divide by 1000
> 15000 = + - [2+0.15*(Span-15000)/1000] 5) Spring force required, < = 28m – 10kgf,
3) D1 & D2 – Span < = 10000 = + - 5 > 28 < = 40m – 12.5kgf
> 10000 < = 20000 = + - 7
> 20000 < = 30000 = + - 9

Name Signature/Date Designation or Company

Inspected by:

D R A
Approved by:

IN AR 15
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 Form NO.: QM.RE.QC.01.10
QC inspection report
MOTOR CURRENTS RECORD ISSUED BY: JESLINE YIP
(CRANE)
EFFECTIVE DATE: 19/7/2011 SUPERSEDES NO.: 15/6/2007
APPROVED BY: ALEX YEO
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: NETWORK NO :

L1 L2 L3
NO. MOTOR CURRENTS (WITH/WITHOUT) LOAD REMARKS
(A) (A) (A)
Slow up
1 HOIST Slow down
Fast up
Fast down

Slow right
2 CROSS TRAVEL Slow left
Fast right
Fast left

Slow forward
3 LONG TRAVEL Slow reverse
Fast forward
Fast reverse

Test Equipment ID : _________________

OTHER REMARKS:

Wiring Diagram No. : _________________

Voltage supply as measured : _____ volts ______ Hz

Name Signature/Date Designation or Company

Inspected by:

D R A
Approved by:

IN2-MAR 15
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 QM.HC.QC.01.
Form NO.:
19
QC inspection report
FUNCTIONAL TEST – LIMIT ISSUED BY: C L CHONG
SWITCH
EFFECTIVE DATE: 1/1/97 ITEM NO.:
APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

DESCRIPTION CHECKED FUNCTIONABLE F/NF

MAIN HOIST - Lifting Limit Switch
- Lowering Limit Switch
- Over Lifting Limit Switch
- Phase Reversal Limit Switch
AUX. HOIST - Lifting Limit Switch
- Lowering Limit Switch
- Over Lifting Limit Switch
- Phase Reversal Limit Switch
LONG TRAVEL - Forward Slow Limit Switch
- Forward Fast Limit Switch
- Reverse Slow Limit Switch
- Reverse Fast Limit Switch
CROSS TRAVEL - Right Slow Limit Switch
- Right Fast Limit Switch
- Left Slow Limit Switch
- Left Fast Limit Switch
TURNTABLE/TILTING - Clockwise Limit Switch
- Anticlockwise Limit Switch
Anticollision Limit Switches
Doba Brake Limit Switches
Over Speed Limit Switches
Cabin Door/Access Limit Switches

Emergency Push Button

Remarks

Name Signature/Date Designation or Company

Inspected by:

Reviewed by:

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Form NO.:
20
QC inspection report
FUNCTIONAL TEST – MOTOR ISSUED BY: C L CHONG
AND SPEED CHECK
EFFECTIVE DATE: 1/1/97 SUPERCEDES NO.:
APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

DESCRIPTION COMPLIANCE
%
SPECIFIED MEASURED WITH TSS
DEVIATION
WITH/WITHOUT LOAD AT (SHOP/SITE) C/NC

A) MAIN HOIST - Lifting slow

- Lifting fast
- Lowering slow
- Lowering fast
B) AUX. HOIST - Lifting slow
- Lifting fast
- Lowering slow
- Lowering fast
C) CROSS TRAVEL - Right slow
- Left slow
- Right fast
- Left fast
D) LONG TRAVEL - Forward slow
- Reverse slow
- Forward fast
- Reverse fast
E) TURNTABLE/TILTING - Right slow
- Left slow
- Right fast
- Left fast
F) BRAKING SYSTEM EFFECTIVE / INEFFECTIVE
Remarks

1) Speed tolerance - +/ - 20% of specified speed

- +25% / -10% of specified speed for hoist lowering with full load, due to slip within the motor, occurring
between no-load and full-load speeds.
2) Measurement of L/T speed shall be free wheel travel rotation (RPM) converted to linear speed (m/min)

Name Signature/Date Designation or Company

Inspected by:

Reviewed by:

D R A
Approved by:

IN2-MAR 15
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Form NO.:
1.06
QC inspection report
JESLINE
ELECTRICAL SEQUENCE CHECK ISSUED BY:
YIP
FOR CONTROL BOX
EFFECTIVE DATE: 24/5/2002 ITEM NO.: APPROVED BY: ALEX YEO

PRODUCT TYPE: PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

JOYSTICK/
PUSH
BUTTON

RELAY/
CONTACTORS

REMARKS :
WIRING DIAGRAM REF NO. _______________

Name Signature/Date Designation or Company

Inspected by:

Reviewed by:

D R A
Approved by:

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Form NO.:
09
QC inspection report
ELECTRICAL INSULATION ISSUED BY: JESLINE YIP
CHECK
EFFECTIVE DATE: 24/5/2002 ITEM NO.:
APPROVED BY: ALEX YEO
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

CABLE U–V V–W W–U

NO. PE-U+V+W REMARKS
NO./MOTORS (ohm) (ohm) (ohm)
(Mohm)
1 HOIST

2 LONG TRAVEL

3 LONG TRAVEL

4 CROSS TRAVEL

5 CROSS TRAVEL

OTHER REMARKS :

Min insulation resistance 0.5 Mohm

Wiring diagram no. __________
When checking multi-core (control cables) disconnect control transformer

Name Signature/Date Designation or Company

Inspected by:

Reviewed by:

D R A
Approved by:

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 QM.HC.QC.01.
Form NO.:
37
QC inspection report
ISSUED BY: C L CHONG
PAINTING CHECKLIST

EFFECTIVE DATE: 1/1/97 ITEM NO.:

APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

COMPLIANCE TO SPEC.
DESCRIPTION COMPLIANCE : C, Non-Compliance : NC REMARKS

A) SURFACE PREPARATION

• Manual Brush St 2
• Manual Brush St 3
• Shot/Grit Blast, SA 2 or 2 1/2

B) PAINT APPLICATION

• Indoor
• Handbrush
• Airless Spray
• Outdoor
• Roller

C) PAINT SPECIFICATION – DFT Measured DFT

--------------------
1st Coat DFT (µm) __________ --------------------
2nd Coat DFT (µm) __________
3rd Coat DFT (µm) __________
--------------------
4th Coat DFT (µm) __________ --------------------

D) MECHANICAL COMPONENT – PAINT

CONDITION

• Hoist Unit
• Winch Unit
• Main Drive Unit, LT
• Crab Drive Unit, CT
• Slewing Drive Unit
• Portal Drive Unit

E) ELECTRICAL EQUIPMENT &

CONTROL BOX – PAINT CONDITION

• Standard Control Box

• POC EL1 Box
• POC EL2 Box

F) Others

Name Signature/Date Designation or Company

Inspected by:

Reviewed by:

D R A
Approved by:

IN2-MAR 15
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 QM.HC.QC.01.
Form NO.:
21
QC inspection report
FUNCTIONAL TEST - ISSUED BY: C L CHONG
DEFLECTION
EFFECTIVE DATE: 17/05/10 SUPERCEDES NO.: 1/1/97
APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

COMPLIANCE WITH
DEFLECTION TEST PROCEDURE AT WORKSHOP/SITE CHECKED
TSS C/NC
Actual Span(L) : __________ mm
Safe Working Load(100%) : __________ kg
Deflection Criterior(L/750) : __________ mm
Design Deflection : __________ mm

1 If at shop rigidly support crane at the end carriage to

required height

2 Prepare load to approx. combination of 30%, 60%, 100% &

125% of SWL.

3 Ensure that all other functional tests being carried out to

satisfaction

4 Provide proper lifting slings for load

5 Lift the 100% SWL to check hoist brake effectiveness

6 Release load, set a deflection gauge line at the center of

span

7 Read the measurement of deflection gauge line when the

beam is unloaded mm

8 Lift 100% SWL with crab/hoist at the centre of girder & read
the deflected measurement mm

9 (8) minus (7) is the deflection

10 Test with 100% SWL on all motions

11 Test with 125% SWL suspended at mid air for 5 minutes

with load at the centre of beam.
Remarks

Name Signature/Date Designation or Company

Inspected by:

D R A
Approved by:

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Form NO.:
QC inspection report 16

COMPONENT IDENTIFICATION ISSUED BY: C L CHONG

RECORD (2)
EFFECTIVE DATE: 1/1/97 ITEM NO.:
APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

COMPLIANCE WITH TSS

DESCRIPTION LONG TRAVEL 1 LONG TRAVEL 2
C/NC
TYPE
SPEED
GEARBOX TYPE
GEARBOX S/NO.
GEARBOX RATIO
SUPPLY V/ PH/ Hz
MAIN MOTOR TYPE
MAIN MOTOR S/NO.
MOTOR CERT. NOS.
KW / RPM / %ED
CREEP MOTOR TYPE
CREEP MOTOR S/NO.
CREEP MOTOR CERT.
NOS.
KW / RPM / %ED
WHEEL TYPE
CARRIAGE TYPE
DRIVE SHAFT TYPE/S/NO.
TORQUE ARM TYPE
RAILS TYPE

Remarks : Other component identification, use QCFT 005

Name Signature/Date Designation or Company

Inspected by:

D R A
Reviewed by:

IN2-MAR 15
1
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Approved by:
 Form NO.: QM.HC.QC.01.17
QC inspection report
COMPONENT IDENTIFICATION ISSUED BY: MARTIN YEO
RECORD (3)
EFFECTIVE DATE: 17/05/2010 SUPERSEDES NO.: 15/07/2009 K.M. Niemann
APPROVED BY:
PRODUCT TYPE:
PAGE 1 OF 1

CLIENT/PROJECT: JOB NO :

COMPLIANCE WITH TSS

DESCRIPTION CROSS TRAVEL 1 CROSS TRAVEL 2
C/NC
TYPE
SPEED
GEARBOX TYPE
GEARBOX S/NO.
GEARBOX RATIO
SUPPLY V/ PH/ Hz
MAIN MOTOR TYPE
MAIN MOTOR S/NO.
MOTOR CERT. NOS.
KW / RPM / %ED
MAIN MOTOR EX-PROOF
CLASSIFICATION (if any)
CREEP MOTOR TYPE
CREEP MOTOR S/NO.
CREEP MOTOR CERT.
NOS.
KW / RPM / %ED
CREEP MOTOR EX-PROOF
CLASSIFICATION (if any)
WHEEL TYPE
CARRIAGE TYPE
DRIVE SHAFT TYPE/S/NO.
TORQUE ARM TYPE
RAILS TYPE
MAIN BRAKE TYPE
MAIN BRAKE S/NO.
MAIN BRAKE CERT. NOS.
MAIN BRAKE EX-PROOF
CLASSIFICATION (if any)
CREEP BRAKE TYPE
CREEP BRAKE S/NO.
CREEP BRAKE CERT. NOS.
CREEP BRAKE EX-PROOF
CLASSIFICATION (if any)

Remarks : Other component identification, use QCFT 005

Name Signature/Date Designation or Company

Inspected by:

D R A
Approved by:

IN2-MAR 15
1
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 QC INSPECTION REPORT FORM NO : QM.HC.QC.01.84

COMPONENT IDENTIFICATION
RECORD ISSUED BY : MARTIN YEO

EFFECTIVE DATE : 15/07/2009 SUPERSEDES NO : dated 01/06/2008 APPROVED BY : K.M. Niemann

PRODUCT TYPE : PAGE 1 OF 1
CLIENT/PROJECT : NETWORK NO :
DESCRIPTION MAIN HOIST / WINCH AUXILIARY HOIST / WINCH COMPLIANCE WITH TSS

Type

Safe-Working-Load (kg)

Lifting Speed (m/min)

Hoist / Winch S/No.

Hoist / Winch Certificate No.

Rope Diameter / Length

Rope Drum Dia. & Length

Rope drum - single/double groove

Bearing Type

Gearbox Type / S/No.

Gearbox gear ratio

Supply ____ V __ph ___Hz

Main Motor / Brake type

Main Motor / Brake S/No.

Main Motor / Brake Certificate No.

kW / RPM / %ED
Main Motor / Brake Ex-proof classification
(if any)

Creep Motor / Brake type

Creep Motor / Brake S/No.

Creep Motor / Brake Certificate No

kW / RPM / %ED
Creep Motor / Brake Ex-proof classification
(if any)

Limit Switch Type

Single/Ramshorn Hook

Markings on hook

Carriage wheel diameter

C/T motor / Brake type

C/T motor / Brake S/No.

C/T motor / Brake Certificate No.

kW / RPM / %ED
C/T Motor / Brake Ex-proof classification (if
any_)
Remarks :

Name Signature/Date Designation or Company

Inspected by :

Approved by :

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