Aerial Work Platform Certification Form.doc

DOC document 45 KB Posted

Attached to
USNS PATUXENT HYSTER Forklift Recertification Federal contract opportunity
Solicitation number
N3220522Q2241
Issued by
Department of the Navy Military Sealift Command

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Combined Synopsis Solicitation.docx DOCX document
CDRL A0001 FINAL CONDITION REPORT.pdf PDF
CDRL A0004 WORK ORDER.pdf PDF
CDRL A0002 Fork Inspection Form.pdf PDF
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Text version

SAFETY INSPECTION AND WEIGHT TEST CERTIFICATION

OF AERIAL MAINTENANCE PLATFORM

USN NO.

COMMAND:

MANUFACTURER:

EQUIPMENT TYPE:

AERIAL MAINTENANCE PLATFORM

SERIAL NUMBER:

BASKET #

MODEL:

MODEL YEAR:

HOUR METER:

CAPACITY:

500 Lbs. Unrestricted

CERTIFICATION:

This is to certify that inspections and tests have been conducted in accordance with procedures set forth in the current NAVFAC P-300 and applicable manufactures technical manual. It is further certified that the above Aerial Maintenance Platform is satisfactory to lift its rated capacity and is fully operational.

· Certified for 500 Lbs., (500 lb. un-restricted). Percent testing 100% .

· Not certified for electrical or hot work

X Annual Certification Special Certification

Certification Date:

Expiration Date:

Inspector (printed name)

Inspector (signature)
Date

MHE-11-2010

REVISED 07/19/10

File details come from the government source that posted it. Updated .