21
PERIODIC CHECKS AND INSPECTIONS
Device Periodic Check Sheet
No.
Date
Reason for
Check
1
Periodic check
Additional check
2
Periodic check
Additional check
3
Periodic check
Additional check
4
Periodic check
Additional check
5
Periodic check
Additional check
6
Periodic check
Additional check
7
Periodic check
Additional check
20
CLUTCH USER MANUAL
Check Results
Notes
(damage, defects,
excessive wear or
other relevant data)
Name & Signature of
Competent Person
Performing Check
Date of
Next
Check