Cal. Code Regs. Tit. 8, div. 1, ch. 4, subch. 7, grp. 13, art. 91, Plate V

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Current through Register 2024 Notice Reg. No. 44, November 1, 2024

State of California Department of Industrial Relations Division of Occupational Safety and Health (Dosh)

CERTIFICATE OF UNIT TEST AND/OR EXAMINATION OF CRANES AND DERRICKS USED FOR LIFTING SERVICE

1. Owner:

___________________________

2. Owner's Address:

___________________________

3. Device (check): Crane

______________________________

Derrick

______________________________

Other

___________________________

Location:

(a) Remains at worksite

______________________________

(b) changes Worksite

(c) On Barge ____________________

___________________________

4. Description:

__________________________________________________

Rated Capacity:

___________________________

5. Manufacturer:

______________________________

Model No.

______________________________

Serial No.

___________________________

6. Owner's Identification (if any):

___________________________

7. Service Status At Time of Survey: Lifting

______________________________

Other (describe)

___________________________

8. Boom At Time of Survey (if luffing type): Length:

______________________________

Type:

9. Test Loads Applied (cross out if only examination conducted):

Radius	Proof Load	Rated Load	Outriggers (yes, no)	Boom Direction (over, rear, over side)
___________________________	___________________________	___________________________	___________________________	___________________________
___________________________	___________________________	___________________________	___________________________	___________________________
___________________________	___________________________	___________________________	___________________________	___________________________
___________________________	___________________________	___________________________	___________________________	___________________________

___________________________

Description of Proof Load:

___________________________

10. Basis for assigned load ratings:

11. The examination shall cover the points listed below as applicable.

___________________________

12. Remarks and/or limitations imposed:

I certify that on the __________ day of ____________________, 19 _____, the above described device was tested __________, examined __________ by the undersigned; that said test and/or examination met with the requirements of the Division of Occupational Safety and Health Administration.

___________________________

Name and Address of authorized certificating agent:

___________________________

U. S. Department of Labor Current Accreditation No. _________________________

Expiration Date	___________________________	Signature: _______________________
Engineer's Registration No.	___________________________
California DOSH Approval No.	___________________________	Title: ___________________________
(whichever applicable)
		Date: ___________________________

The examination shall be carried out in conjunction with each unit proof load test. The qualified person, or his authorized representative, shall make a determination as to requirements for the correction of deficiencies found. The examination shall cover the following points as applicable:

1. All functional operating mechanisms for improper function, maladjustment, and excessive component wear, with particular attention to sheaves, pins, and drums. This shall include operation with partial load, in which all functions and movements, including, where applicable, maximum possible rotation in both directions, are performed.

2. All safety devices for malfunction.

3. Deterioration or leakage in lines, tanks, valves, drains, pumps, and other parts of air or hydraulic systems.

4. Loose gear components (i.e., hooks, etc.), including wire rope and wire rope terminals and connections, with particular attention to sections of wire rope exposed to abnormal wear and sections not normally exposed for examination. Cracked or deformed hooks shall be discarded.

5. Rope reeving for compliance with certifying agent's recommendations.

6. Deformed, cracked, or excessively corroded members in crane structure and boom.

7. Loose bolts, rivets, or other connections.

8. Worn, cracked, or distorted parts affecting safe operation.

9. Excessive wear on and free operation of brake and clutch system parts, linings, pawls, and ratchets.

10. Load, boom angle, or other indicators shall be checked for any significant inaccuracy.

11. It shall be ascertained that there is a durable rating chart visible to the operator, covering the complete range of the certified agent's capacity ratings at all operating radii, for all permissible boom lengths and jib lengths, with alternate ratings for optional equipment affecting such ratings. Necessary precautions or warnings shall be included and operating controls marked or an explanation of controls shall be posted at the operator's position to indicate function.

12. Careful examination of the junction areas of removable boom sections, particularly for proper seating, cracks, deformities, or other defects in securing bolts and in the vicinity of such bolts.

13. It shall be ascertained that no counterweights in excess of the certified agent's specifications are fitted.

14. Such other examinations deemed necessary under the circumstances.

Cal. Code Regs. Tit. 8, div. 1, ch. 4, subch. 7, grp. 13, art. 91, Plate V

1. Amendment filed 2-13-75; effective thirtieth day thereafter (Register 75, No. 7).
2. Amendment filed 7-17-75; effective thirtieth day thereafter (Register 75, No. 29).
3. Amendment filed 1-2-76; effective thirtieth day thereafter (Register 76, No. 1).
4. Amendment filed 7-6-79; effective thirtieth day thereafter (Register 79, No. 27).
5. Repealer of Plate IV and Plate C-11-b filed 1-17-80; effective thirtieth day thereafter (Register 80, No. 3).
6. Amendment of Plate V filed 7-2-80 as procedural and organizational; effective upon filing (Register 80, No. 27).
7. Amendment of Plates I, II and V filed 8-29-86; effective thirtieth day thereafter (Register 86, No. 39).
8. Change without regulatory effect amending section filed 10-26-90 pursuant to section 100, title 1, California Code of Regulations (Register 91, No. 9).
9. New Figure 17-a filed 4-16-93; operative 5-17-93 (Register 93, No. 16).
10. Amendment of caption for Figure 15 filed 1-3-2002; operative 2-2-2002 (Register 2002, No. 1).
11. Change without regulatory effect providing more legible illustrations for Plate I (Figures 1-21), Plate II (Figures 1-6) and Plate III (figures 1-4) filed 3-2-2009 pursuant to section 100, title 1, California Code of Regulations (Register 2009, No. 10).

Note: Authority cited and Reference: Section 142.3, Labor Code.