CHAVEZ CDRL A0001 Final Condition Report (2).pdf

G. PREPARED BY

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

16. REMARKS

C. CATEGORY:

TDP ________ TM _______ OTHER _________________________

Form Approved OMB No. 0704-0188

15. TOTAL

PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

H. DATE J. DATEI. APPROVED BY

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

Designed using Perform Pro, WHS/DIOR, Aug 96

CDRL 0003

D. SYSTEM/ITEM

0003 Final Job Sign Off/Final Inspection Form

SOW Para 3.10 and 3.11.1 N32205

N/A As Required As Required

As Required As Required N/A

MHE Help Desk

MSC_MHEOHE@US.NAVY.MIL

A finalized MHE Inspection Form filled out IAW, NAVSUP PUBLICATION 538 SIXTH REVISION for each unit identifying the current operational condition, status of safety devices and all required repairs. The hard copy form and electronic copy sent via email, will be provided to the MSC N44 MHE Help Deck (CDRL 0003)

Page ____ of 1 4 Pages

MHE Hyster Forklifts

NAVSUP PUBLICATION 538 SIXTH REVISION

SHIPBOARD UNIT SHOREBASED UNIT INSPECTION DATE

MAKE MHE TYPE BLADE LENGTH

MODEL MOTOR TYPE FUEL TYPE

YEAR TIRE TYPE HOUR METER READING

SERIAL NO. CAPACITY EQUIPMENT COST CODE

Item No.

Inspection Point Accept Reject N/A

1 Manufacturer’s data/identification plate

2 Manufacturer’s “STRUCTURALLY WEIGHT TESTED” marking (ammunition or shipboard handling)

3 Accredited laboratory certification plate (e.g., UL, FM)

4 Alphabetical designation (EE, DS, etc.)

5 Operational controls correctly labeled/marked

6 Battery identification plate or marking

7 Fuel type marking (e.g., DIESEL FUEL ONLY)

8 Warning decals and labels

9 Safe working load marking (sides and mast) (e.g., SWL 6000 LBS)

10 Vehicle weight marking (sides and mast) (e.g., VW 10,000 LBS)

11 Registration number (e.g., 13-20000)

12 SLEP data plate

13 “LEAD AND CHROMATE FREE PAINT” marking

14 “LIFT HERE” marking

15 “TIEDOWN” marking

16 Tire pressure marking (pneumatic only)

17 Fuel cap (color coded)

18 “SHIPBOARD USE APPROVED” marking

19 Blue diagonal striping (type EX only)

20 Instruction plates

21 Grease fittings (on components) fully filled and accessible

22 Correct fluid levels (brake, radiator, transmission, hydraulic, etc.)

23 Paint is smooth and adheres well

24 No evidence of loose, missing or broken hardware

25 No evidence of bent, cracked or worn accessories

26 No evidence of missing covers, panels, loose or poor fit

27 Overhead guard and load backrest (cargo guard) not damaged

MHE Final Inspection Form

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lawrence.l.debeau1 Cross-Out

28 Forks are straight within 1% of length

29 Hydraulic cylinders: no weld cracks, leaks or other damage

30 Neoprene hydraulic lines: free of paint, routed correctly and secured

31 Towing devices, hitch pins, tow chains, etc. are attached

32 Battery cables: secure, no cuts/abrasions, and protected by non-conductive covers

33 Battery mounts and hold downs are secure

34 Wiring harness is correct with no frayed, brittle or crimped connections (soldered only)

35 Tires are correct type, size and thread (no delamination shall be accepted)

36 Wheel lugs are torqued as specified

37 Check mast rollers and locks

38 Fork heel pins and locks function

39 Lift chains and anchor pins are secure and functional

40 Operator pedals are equipped with rubber pads or non-slip coating

41 Operator restraint system/seat belt equipped and functional

42 Dash gauges are correct and marked

43 Key ignition switch (verify key numbers match contract numbers)

44 Start MHE and note any unusual noises

45 Weight gauge is legible and operable

46 Steering wheel is smooth and little free play

47 Verify all gauges function

48 Verify hourmeter operates properly

49 Verify horn operates

50 Verify back-up alarm operates

51 Verify all lights operate: brake, spot, battle/blackout, etc.

52 No evidence of steering play or loose suspension

53 Bring to full operating temperature (fuel power only) and check for leaks

54 Check for arcing and operation of contactors, traction, steer and hydraulic pump motors (electric MHE only)

55 Battery disconnect switch is operable

56 Check accelerator and inching/declutching pedal operation

57 Check brake operation

Item No.

Inspection Point Accept Reject N/A

MHE Final Inspection Form (Continued)

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8-20

Item No.

Inspection Point Accept Reject N/A

58 Parking brake functions

59 Check emergency stop operation

60 Check for smoothness when raising mast to full height

61 Verify hose reel functions smoothly

62 Check tilt and side shift (rotation some models) operation and smoothness

63 Check acceleration (all forward and reverse gears)

64 Check braking (at speed) if smooth and straight

65 Check transmission (forward and reverse)

66 Clutch adjustment, engagement and operation

67 Check for exhaust leaks

68 Check applicable steering modes (2 wheel, 4 wheel, crab)

69 Verify the turning radius/tracking

70 For electric trucks, the presence of static conductive straps or tires

INSPECTION ACTIVITY INSPECTOR NAME DATE (MMDDYY)

PRINT:

SIGNATURE:

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MHE Final Inspection Form (Continued) lawrence.l.debeau1 Cross-Out

DD FORM 1423-1, AUG 96

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;

Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

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