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PROCES VERBAL

DE VERIFICARE PERIODICA A ECHIPAMENTULUI DE MUNCA

Denumire/descriere echipament:__________________________________________

Numar inventar:_______________________________________________________

Numar serie(N/A):_____________________________________________________

Data efectuarii inspectiei tehnice:_________________________________________

Stare subsisteme componente echipament:


- ……………………………………………... [ ] functional [ ] defect
- …………………...………………………… [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect
- ……………………………………………... [ ] functional [ ] defect

Constatari si mentiuni in urma verificarii:


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In urma inspectiei tehnice echipamentul este:

[ ] Bun de exploatare [ ]Trimis la reparat [ ]Trimis la casat

Nume verificator:__________________________ Semnatura:

*Echipamentul va fi inspectat vizual de catre utilizator(i) inaintea fiecarei utilizari.


*Valabilitatea inspectiei tehnice este de 6 luni de la data efectuarii acesteia sau pana la
urmatoarea data programata pentru inspectie generala a echipamentelor daca aceasta data este
mai mica decat durata valabilitatii inspectiei.

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