1, OK Needs Re pair N/A Notes Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equipment #: Inspection date: Inspection Company: Inspector #: Tonnage: 2 Insert size: OK Needs Re pair N/A Notes Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equipment #: Inspection date: Inspection Company: Inspector #: Tonnage: 3 Insert size: OK Needs Re pair N/A Notes Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equipment #: Inspection date: Inspection Company: Inspector #: Tonnage: 4 Insert size: OK Needs Re pair N/A Notes Check springs Check rod release springs Check elevator bail Snap rings in place
7, OK Needs Re pair N/A Notes Check safety latch Are latch inserts worn Make: Model: Serial #: Equipment #: Inspection date: Inspection Company: Inspector #: Tonnage: 8 Insert size: OK Needs Re pair N/A Notes Check springs Check rod release springs Check elevator bail Snap rings in place Insert condition All screws in insert Check elevator body Check safety latch Are latch inserts worn Make: Model: Serial #: Equipment #: Inspection date: Inspection Company: Inspector #: Tonnage: 1 Insert size: OK Needs Re pair N/A Notes Check D-ring Check i-bolt Check transfer body Check bearing Make: Model: Serial #: (if applicable) Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: (if applicable) Tonnage: 2 Insert size: OK Needs Re pair N/A Notes Check D-ring Check i-bolt Check transfer body Check bearing Make: Model: Serial #: (if applicable) Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: (if applicable) Tonnage: 3 Insert size: OK Needs Re pair N/A Notes Check D-ring Check i-bolt Check transfer body Check bearing Make: Model:
3, Serial #: (if applicable) Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: (if applicable) Tonnage: 4 Insert size: OK Needs Re pair N/A Notes Check D-ring Check i-bolt Check transfer body Check bearing Make: Model: Serial #: (if applicable) Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: (if applicable) Tonnage: 5 Insert size: OK Needs Re pair N/A Notes Check D-ring Check i-bolt Check transfer body Check bearing Make: Model: Serial #: (if applicable) Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: (if applicable) Tonnage: 6 Insert size: OK Needs Re pair N/A Notes Check D-ring Check i-bolt Check transfer body Check bearing Make: Model: Serial #: (if applicable) Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: (if applicable) Tonnage: OK Needs Re pair N/A Notes Check for cracks Check for scarring Check ears for gouging Make: Model: Serial #: Equipment #: Inspection date: Inspection Company: (if applicable) Inspector #: Tonnage: OK Needs Re pair N/A Notes Check for wear Check pins & bolts for wear Safety/cotter pins in place Make: Model: Serial #: Equipment #: LOAD
OK Needs Re pair N/A Notes Washers/cotter pins or pin connections Pins Pinholes in lugs Threaded connections Auxiliary brake or equivalent Any other load bearing mechanical brake OK Needs Re pair N/A Notes Brake bands Brake links - welded Brake links – solid Brake turnbuckles Brake equalizer Threaded connections Pins Pinholes in lugs Brake block wear Flange condition Threaded connections OK Needs Re pair N/A Notes Brake bands Welded external lugs Linkage arm Drawworks input lug Bearing blocks Washers/cotter pins or pin connections Pins Pinholes in lugs Threaded connections OK Needs Re pair N/A Notes Brake bands Brake links - welded Brake links – solid Brake turnbuckles Brake equalizer Threaded connections Pins Pinholes in lugs Brake block wear Flange condition CARRIER MOUNTED EQUIPMENT OK Needs Re pair N/A Notes Off Drillers side main beam Load line lugs Turnbuckle lug weld Drillers side main beam Cross member connection Turnbuckle pin connection
OK Needs Re pair N/A Notes Pin condition Frame Threaded legs OK Needs Re pair N/A Notes Tie down Rack structure OK Needs Re pair N/A Notes Pins and lugs (outrigger to carrier) Frame condition Frame welds Guy line lugs Spreader bar condition Screw jack condition All keeper pins and chains Belly jack condition Belly jack attachment points Mat condition OK Needs Re pair N/A Notes Raising ram condition Raising ram connection OK Needs Re pair N/A Notes Drill line anchor bolts Drill line anchor welds LEVEL III INSPECTION COMPLETION This Level III Inspection been logged in the Overhead Equipment Log Book This Level III Inspection was done in accordance with CAODC RP’s: 3.0, 4.0, 10.0 and 11.0 Inspector’s signature: Field superintendent’s signature: Estimated completion date for all repairs: