MHD56114 - Edition 4
21
INSPECTION AND MAINTENANCE REPORT
Ingersoll-Rand Force 5 Series FA2.5A Air Winch
Model Number:
Date:
Serial Number:
Inspected by:
Reason for Inspection: (Check Applicable Box)
1. Scheduled Periodic Inspection:
(_____ Quarterly _____ Semiannually _____ Yearly)
Operating Environment:
Normal: ___ Heavy: ___ Severe: ___
2. Discrepancy(s) noted during Frequent Inspection
3. Discrepancy(s) noted during maintenance
4. Other: ___________________________
Refer to the Parts, Operation and Maintenance Manual “INSPECTION” section for general inspection criteria. Also, refer to appropriate
National Standards and Codes of practice. If in doubt about an existing condition, contact the nearest
Ingersoll-Rand
Distributor or the
factory for technical assistance.
COMPONENT
CONDITION
CORRECTIVE
ACTION
NOTES
Pass
Fail
Repair
Replace
Uprights and
Side Rails
Drum Band Brake
(125% Load Test)
Disc Brake
(125% Load Test)
Drum Band Brake
(Visual Inspection)
Disc Brake
(Visual Inspection)
Motor
Controls
Air System
Fasteners
Reduction Gears
Labels and Tags
---
Shafts
Drum Guard
Wire Rope Wedge
---
Emergency Stop Valve
Overload Device
---
Wire Rope
---
Other Components
(list in NOTES section)
TESTING
Pass
Fail
NOTES
Operational (No Load)
Operational (10% Load)
Operational (Maximum Test Load*)
* Maximum test load is 125% of rated line pull. Testing to more than 125% of rated load may be required to comply with standards and
regulations set forth in areas outside the USA.
This form may be copied and used as an inspection/maintenance record.
