Ingersoll-Rand FA5T Inspection And Maintenance Report, Model Number, Date, Serial Number, Action

INSPECTION AND MAINTENANCE REPORT

Ingersoll-Rand Force 5 Series FA5 and FA5T Air Winches

Model Number:			Date:
Serial Number:			Inspected by:
Reason for Inspection: (Check Applicable Box)
	1.	Scheduled Periodic Inspection	Operating Environment:
	(_____ Quarterly _____ Semiannually _____ Yearly)
	2.	Discrepancy(s) noted during Frequent Inspection	Normal ___ Heavy ___ Severe ___
	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-RandDistributor or the factory for technical assistance.

	CONDITION		CORRECTIVE
COMPONENT			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
Limit Switches
Controls
Air System
Fasteners
Reduction Gears
Labels and Tags			---
Shafts
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.

MHD56037 - Edition 5 23