GA1

Report of Thorough Examination

NOTE:
This form may be used to record the thorough examination and testing of Lifting Equipment, as set out in the Safety, Health and Welfare at Work (General Application) Regulations, 2007. This form was produced by the HSA to facilitate the recording of information, as per Schedule 1 Part E of these regulations. This form must be
completed by a competent person. This is not an approved or statutory form.

Date
Reference
Name and address of employer or owner for whom the thorough examination was made:*

Name and address of employer or owner for whom the thorough examination was made:
Address where thorough examination was made*

Address where thorough examination was made
Particulars identifying the lifting equipment*

Particulars identifying the lifting equipment
Type of lifting equipment
Serial Number
Year of manufacture
SAFE WORKING LOAD & CONFIGURATIONS
Note: Each configuration should reflect the working arrangements, for example length of jib; fly jib; radius; angle; ballast; number of rope falls; heightunder hook. Please detail the safe working loads for all configurations, as per manufacturer's instructions.
Safe Working Load (a)
Configuration (a)*

Configuration (a)
Safe Working Load (b)
Configuration (b)

Configuration (b)
Safe Working Load (c)
Configuration (c)

Configuration (c)
Testing / Thorough Examination
- Testing
- Thorough Examination
Purpose of testing
Purpose of thorough examination:
Particulars of tests carried out*

Particulars of tests carried out
Latest date for next thorough examination

Latest date for next thorough examination:
Defect which is a danger to persons:

Defect which is a danger to persons:
Repair, renewal or alteration required to remedy this defect
Indicate if the immediate cessation of use has been advised

Repair, renewal or alteration required to remedy this defect
Defect which could become a danger to persons

Defect which could become a danger to persons
Timeframe for defect becoming a danger

Timeframe for defect becoming a danger
Repair, renewal or alteration required to remedy this defect,including date(s)

Repair, renewal or alteration required to remedy this defect,including date(s)
Parts not accessible for examination

Parts not accessible for examination
Name, address and qualifications of competent person making the report:*

Name, address and qualifications of competent person making the report:
Your Email Address*

Your Email Address
Employer
Name and position of person authenticating the report*

Name and position of person authenticating the report
Email of person authenticating report*

Email of person authenticating report

We'll send a copy of the GA1 form to this email address
Employer
We certify that: (Tick when done)*
- Select All
- We have undertaken the test / thorough examination as prescribed
- We have identified defects which are or could be a danger to persons
- This test/thorough examination has been carried out by a competent person
- The particulars in this report of thorough examination are correct
You must: (tick to confirm you understand)*
- Select All
- Keep this report of thorough examination safe and available for inspection
- Undertake identified repairs
- Arrange for a thorough examination or test before the latest date or as prescribed
Signature*
Competent person performing tests or thorough examination
Signature*
The person receiving the report of a thorough examination

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Report of Thorough Examination

GA1