CDRL A0003 SAFETY CERTIFICATION.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) 0MB No. 0704-0188

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J.DATE

17. PRICE GROUP

Production

18. ESTIMATED

TOTAL PRICE

$47,500.00

DD FORM 1423-1, AUG 96 (EG) PREVIOUS EDITION MAY BE USED. Page_1_of_1_Pages Designed using Perform Pro, WHS/DIOR, Aug 96

A. CONTRACT LINE ITEM NO.

CDRLA0003

B. EXHIBIT C. CATEGORY:

TDP TM --- OTHER

D. SYSTEM/ITEM

MHE Hyster Forklifts I

E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO.

2. TITLE OF DATA ITEM

MHE Safety Certification

4. AUTHORITY (Data Acquisition Document No.)

sow

5. CONTRACT REFERENCE

1 Para 6.6

6. REQUIRING OFFICE

N32205

7. DD250 REQ

N/A

8. APP CODE

9. DIST STATEMENT

REQUIRED

N/A

10.FREQUENCY

As Required

12.DATE OF FIRST SUBMISSION

As Required

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

11.AS OF DATE

As Required

13.DATE OF SUBSEQUENT

SUBMISSION

As Required

Draft Reg

Final

Repro

16.REMARKS

Service provider shall submit a safety certification on each forklift/pallet jack asset to Military Sealift Command, Norfolk, VA. This safety certification denotes the applicable 18-month periodic test shall identify the overall condition of each asset and list all necessary repairs required to meet the operational and safety specifications of NAVSEA SWO23-AH-WHM-010 EIGHT REVISION, MHE Safety Certification Form.

(CDRL0003).

G.PREPARED BY H.DATE I. APPROVED BY

MHE HELP DESK

MSC MHEOHE@US.NA VY.MIL

15. TOTAL

David Crossley 11/4/2022 mailto:MHEOHE@US.NA

NAVSEA SW023-AH-WHM-010 EIGHTH REVISION

FIGURE 6-1. MHE Safety Certification Form Click Here to reproduce and annotate this form

6-5

MARKINGS

FUEL SYSTEM

NEUTRAL START SWITCH

(Fueled MHE)

WARNING DEVICES

(Powered MHE)

SPARK EMISSION

(Powered MHE)

STATIC DISCHARGE

(Electric and HS/Ordnance Pallet Truck)

OHMS _ OHMS

CARRIAGE REACH & ROLLER

(Reach & Tier)

DRIVE CONTROL

(Powered Pallet Trucks)

BRAKE

(Except Straddle Carriers and Manual Pallet Trucks)

BRAKE

(Straddle Carrier)

OPERATIONAL WEIGHT TEST

(Forklift Trucks)

OPERATIONAL WEIGHT TEST

(Powered Pallet Trucks)

KING PIN (Straddle Carrier)

LIFTING WEIGHT TEST

(Straddle Carrier)

OVERLOAD WEIGHT TEST

(Except Pallet Trucks and Straddle Carriers)

LIFT EYES

(Except Straddle Carriers)

THIS IS TO CERTIFY THAT THE ABOVE MHE WAS INSPECTED AND TESTED IN ACCORDANCE WITH NAVSEA SW023-AH-WHM-010.

MECHANIC/MAINTENANCE PROVIDER:

PRINT FULL NAME

CERTIFIED BY:

SIGNATURE DATE

PRINT FULL NAME SIGNATURE

THIS 18 MONTH CERTIFICATION EXPIRES ON:

MONTH/YEAR

DATE