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
2 digit month, 2 digit day, 4 digit 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
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Structural
1
2
3
4
Eye Bolts
5
6
7
8
Power Cord Handle
9
10
11
12
Carry Handle
13
14
15
16
Anti-Withdrawal
17
18
19
20
Type of Socket
*
Roof Top 1: Sockets
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Lock Pins
21
22
23
24
Lanyards
25
26
27
28
Pivot Shaft
29
30
31
32
Davit Retainer
33
34
35
36
Anti-Withdrawal
37
38
39
40
Welds
41
42
43
44
Handles
45
46
47
48
Rust
49
50
51
52
Structure
53
54
55
56
Resting Bar
57
58
59
60
Cotter Pins
61
62
63
64
1" Washers
65
66
67
68
Roof Top 1: Pedestal
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Rust
69
70
71
72
Corrosion
73
74
75
76
Welds
77
78
79
80
Deformation
81
82
83
84
Structure
85
86
87
88
Roof Top 1:Outrigger
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Handles
89
90
91
92
Casters
93
94
95
96
Pulleys
97
98
99
100
Delrin Guides
101
102
103
104
Structure
105
106
107
108
Beams
109
110
111
112
Load Rating Tags
113
114
115
116
Welds
117
118
119
120
Roof Top 1: Slide Thru Outriggers
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Delrin Guides
121
122
123
124
Beam
125
126
127
128
Load Rating Tag
129
130
131
132
Shackles
133
134
135
136
Structure
137
138
139
140
Frames
141
142
143
144
All Thread Casters
145
146
147
148
Type of Tie-Back Device
Roof Top 1:Tie-Back Device
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
General Conditions
149
150
151
152
Deformation
153
154
155
156
Corrosion
157
158
159
160
Roof Top 1: Parapet
*
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Tie-Back
161
162
163
164
Dog-Line
165
166
167
168
Stripping
169
170
171
172
Condition
Parapet Height
*
Does Not Meet Code
Meets Code
Caution Sign
*
Yes
No
Roof Top 1:Other Conditions
Rows
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
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Structural
173
174
175
176
Eyebolts
177
178
179
180
Power Cord Hanger
181
182
183
184
Carry Handle
185
186
187
188
Anti-Withdrawal Device
189
190
191
192
Type of Socket: Secondary Structure
Sockets: Secondary Structure
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Lock Pins
193
194
195
196
Lanyards
197
198
199
200
Pivot Shaft
201
202
203
204
Davit Retainer
205
206
207
208
Anti-Withdrawal Device
209
210
211
212
Pedestal: Secondary Structure
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
Rust
213
214
215
216
Corrosion
217
218
219
220
Welds
221
222
223
224
Deformation
225
226
227
228
Structure
229
230
231
232
Roof Top 2:Tie-Back Device
Rows
Inspected
Repair Needed
Parts Removed
Not Applicable
General Conditions
233
234
235
236
Deformation
237
238
239
240
Corrosion
241
242
243
244
Roof Top 2:Other Conditions
Rows
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
Rows
Repairs necessary to pass inspection (Please fill out completely)
1
2
3
4
5
6
7
8
9
10
Optional Repairs/Upgrades
Rows
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
*
Submit
Should be Empty: