Inspection and Maintenance Report
Socket and Davit
Job Location
*
Street Address
Street Address Line 2
City
State
Zip Code
Date Of Inspection
-
Month
-
Day
Year
Date
Technicians
*
Type Of Inspection
*
Building Height
Year Built
OPOS and/or Manual
OPOS
Building Manual
Primary Roof Structure
Type of Davit
*
Roof Top 1: Davits
*
Inspected
Repair Needed
Parts Removed
Not Applicable
Structural
Eye Bolts
Power Cord Handle
Carry Handle
Anti-Withdrawal
Type of Socket
*
Roof Top 1: Sockets
*
Inspected
Repair Needed
Parts Removed
Not Applicable
Lock Pins
Lanyards
Pivot Shaft
Davit Retainer
Anti-Withdrawal
Welds
Handles
Rust
Structure
Resting Bar
Cotter Pins
1" Washers
Roof Top 1: Pedestal
*
Inspected
Repair Needed
Parts Removed
Not Applicable
Rust
Corrosion
Welds
Deformation
Structure
Roof Top 1:Outrigger
*
Inspected
Repair Needed
Parts Removed
Not Applicable
Handles
Casters
Pulleys
Delrin Guides
Structure
Beams
Load Rating Tags
Welds
Roof Top 1: Slide Thru Outriggers
*
Inspected
Repair Needed
Parts Removed
Not Applicable
Delrin Guides
Beam
Load Rating Tag
Shackles
Structure
Frames
All Thread Casters
Type of Tie-Back Device
Roof Top 1:Tie-Back Device
*
Inspected
Repair Needed
Parts Removed
Not Applicable
General Conditions
Deformation
Corrosion
Roof Top 1: Parapet
*
Inspected
Repair Needed
Parts Removed
Not Applicable
Tie-Back
Dog-Line
Stripping
Condition
Parapet Height
*
Does Not Meet Code
Meets Code
Caution Sign
*
Yes
No
Roof Top 1:Other Conditions
Write in all that apply
Power:
Mfg. of Suspension Device
# of Davits
# of Pedestals
Manual Winch
Electric Winch
Secondary Roof Structure
Type of Davit: Secondary Structure
Davits: Secondary Structure
Inspected
Repair Needed
Parts Removed
Not Applicable
Structural
Eyebolts
Power Cord Hanger
Carry Handle
Anti-Withdrawal Device
Type of Socket: Secondary Structure
Sockets: Secondary Structure
Inspected
Repair Needed
Parts Removed
Not Applicable
Lock Pins
Lanyards
Pivot Shaft
Davit Retainer
Anti-Withdrawal Device
Pedestal: Secondary Structure
Inspected
Repair Needed
Parts Removed
Not Applicable
Rust
Corrosion
Welds
Deformation
Structure
Roof Top 2:Tie-Back Device
Inspected
Repair Needed
Parts Removed
Not Applicable
General Conditions
Deformation
Corrosion
Roof Top 2:Other Conditions
Write in all that apply
Power:
Mfg. of Suspension Device
# of Davits
# of Pedestals
Manual Winch
Electric Winch
Summary
Inspection Summary
*
Repair Summary
Required Repairs
Repairs necessary to pass inspection (Please fill out completely)
1
2
3
4
5
6
7
8
9
10
Optional Repairs/Upgrades
Recommended Repairs but not necessary to pass inspection (Please fill out completely)
1
2
3
4
5
6
7
8
9
10
Photos
Photo 1
*
Photo 2
*
Photo 3
*
Photo 4
Photo 5
Photo 6
Drawings
Draw On Image
Conclusion and Signature
Lead Technician
*
First Name
Last Name
Conclusion
*
Inspection has passed
Inspection has failed
Incomplete (need to return)
Technician Signature
*
Clear
Submit
Should be Empty: