CDRL C0001.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB No. 0704-0188

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17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

1 SOW N32205 (MSC N441)

18. ESTIMATED

TOTAL PRICE

7. DD250 REQ

DD

9. DIST STATEMENT

REQUIRED

SEE BLOCK 16

10.FREQUENCY

ASGEN

12.DATE OF FIRST SUBMISSION

SEE BLOCK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8.APP CODE

N/A

11.AS OF DATE

N/A

13.DATE OF SUBSEQUENT

SUBMISSION

N/A

Final Draft

Reg Repro

16.REMARKS

A MHE Safety Certification Form shall be submitted for each forklift or pallet jack asset in accordance with

NAVSUP Publication 538 (6th Rev) and NAVSEA SW023-AH-WHM-010 (8th Rev) Figure 6-1 at the completion of all other work and testing in accordance with Table 6-1.

Test criteria are documented in Chapter 6 of SW023-AH-WHM-010.

Any item failing to pass the test criteria shall be documented in a Condition Report (CDRL A0001) .

Successful testing is documented directly on the Figure 6-1 form.

Forms shall be submitted in an Adobe or Microsoft compatible format with the following file naming convention:

CDRL#_MSC Barcode_Date in YYYYMMDD format example: CDRLD001_23-02785_20230821

MSC_MHEOHE@US.NAVY.M IL

15. TOTAL

G.PREPARED BY H.DATE I.APPROVED BY

HADLEY.RICHARD.T.III.1 Digitally signed by Digitally signed by

454717569

HADLEY.RICHARD.T.III.1454717569 LEWIS.DENNIS.JAMES.1053575079

Date: 2024.02.12 14:07:59 -05'00' Date: 2024.02.14 09:34:06 -05'00'

J.DATE

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

A. CONTRACT LINE ITEM NO.

CLIN 0001

B. EXHIBIT

C

C. CATEGORY:

XXXX

TDP TM ---------------- OTHER

D. SYSTEM/ITEM

I

E. CONTRACT/PR NO.

Material Handling Equipment 1301136689

F. CONTRACTOR

3. SUBTITLE 1. DATA ITEM NO.

C0001

2. TITLE OF DATA ITEM

MHE Safety Certification Report Form mailto:MSC_MHEOHE@US.NAVY.M

6-8

NAVSEA SW023-AH-WHM-010 EIGHTH REVISION

USN/MSC REGISTRATION NO. MHE CLASS/LIFT CODE/TYPE SWL

HOUR �!:..A����

METER

DATE

MARKINGS

TEST PARAGRAPH PROCEDURE RESULTS

FUEL SYSTEM

NCU fRAL.::, IA� I �n, 11..M

(Fueled MHE)

WARNING DEVICES

(Powered MHE)

SPARK EMISSION

(Powered MHE)

STATIC DISCHARGE

(Electric and HS/Ordnance

Pallet Truck)

CARRIAGE REACH & ROLLER

(Reach & Tier)

DRIVE CONTROL

(Powered Pallet Trucks)

BRAKE

(Except Straddle Carriers and Manual Pallet Trucks)

6-6.6 CONDUCTOR TYPE: TIRES STRAPS N/A

I

6-6.9.1 TRAVEL DISTANCE (TABLE 6-2):

-- FEET ACCEPT REJECT N/A

BRAKE

(Straddle Carrier)

OPERATIONAL WEIGHT TEST

6-6.11

100% RATED LOAD

ACCEPT REJECT N/A

(Forklift Trucks) HELD FOR 2 MINUTES:

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

6-5.4 AFTER REPAIR/REPLACEMENT YES NO

N/A

(Except Straddle Carriers) 150% WEIGHT OF MHE HELD FOR ACCEPT REJECT N/A

2 MINUTES:

TIDS 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 SIGNATURE

CERTIFIED BY:

PRINT FULL NAME SIGNATURE

THIS 18 MONTH CERTIFICATION EXPIRES ON:

MONTHNEAR

FIGURE 6-1. MHE Safety Certification Form

6-5

6-6.1 VISUAL INSPECTION: ACCEPT REJECT

6-6.2 LEAK INSPECTION: ACCEPT REJECT N/A

6-6.3 OPERATIONAL INSPECTION: ACCEPT REJECT N/A

6-6.4 OPERATIONAL INSPECTION: ACCEPT REJECT N/A

6-6.5 VISUAL INSPECTION: ACCEPT REJECT N/A

RESISTANCE READING:

LEFT -OHMS RIGHT_ OHMS

N/A

6-6.7

OPERATIONAL INSPECTION:

ACCEPT

REJECT

6-6.8 OPERATIONAL INSPECTION: ACCEPT

PEDAL FEEL: ACCEPT REJECT N/A

6-6.9.2 PARKING BRAKE: ACCEPT REJECT N/A

6-6.9.3 SAFETY BRAKING/DISCONNECT ACCEPT REJECT N/A

SYSTEM:

6-6.10 OPERATIONAL INSPECTION: ACCEPT REJECT N/A

6-6.12

6-6.13

100% RATED LOAD

HELD FOR 2 MINUTES:

VISUAL INSPECTION:

6-6.14 100% RATED LOAD: ACCEPT REJECT N/A

6-5.3 AFTER REPAIRS/MODIFICATIONS

AFFECTING LOAD-BEARING YES NO N/A

COMPONENTS

100% LOAD HELD FOR 2 MINUTES:

6-7

ACCEPT REJECT N/A

150% LOAD HELD FOR 2 MINUTES: ACCEPT REJECT N/A

NAVSEA SW023-AH-WHM-010 EIGHTH REVISION

Table 6-1. Periodic Tests for MHE

Note: Overload weight testing shall only be conducted whenever MHE has undergone repairs or modifications affecting load-bearing components.

*Electric-powered MHE contain designations E, EE, or EX.

**Fuel-powered MHE contain designations CN, CNS, D, DS, DY, G, G/CN, GS, GS/CNS, LP, LPS, G/LP, or GS/LPS.

6-4

Test

Forklift/

Swingmast

(Electric)*

Forklift/

Swingmast

(Fuel)**

Rough

Terrain

(Fuel)**

Sideloader

(Electric)*

Reach &

Tier

(Electric)*

Pallet Truck

(Electric* or Manual)

Straddle

Carrier

(Fuel)**

Markings (6-6.1) X X X X X X X

Fuel System

(6-6.2)

X X X

Neutral Start Switch

(6-6.3)

X X X

Warning Devices

(6-6.4)

X X X X X X

Electric only

X

Spark Emission

(6-6.5)

X X X X X X

Electric only

X

Static Discharge

Test (6-6.6)

X X X X

HS/Ordnance and Electric only

Carriage Reach and

Roller Inspection (6-6.7)

X

Drive Control Test

(6-6.8)

X

Electric only

Brake Tests

(6-6.9)

X X X X X X

Brakes

(6-6.10)

X

Operational Weight

Test (6-6.11)

X X X X X

Operational Weight

Test (6-6.12)

X

King Pin

(6-6.13)

X

Lifting Weight Test

(6-6.14)

X

Overload Weight Testing

(See Note and 6-7)

X X X X X

Lifting Eyes Test (See

Note and 6-8)

X X X X X X