California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 4 - Division of Industrial Safety
Subchapter 7 - General Industry Safety Orders
Group 13 - Cranes and Other Hoisting Equipment
Article 91 - Definitions
Plate V - State of California Department of Industrial Relations Division of Occupational Safety and Health (Dosh)
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
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:
______________________________
___________________________
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.
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.