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Check list for custom designed products                                  Competence in lifting technology



            Company: ....................................................  Date ............................................................
            Official in charge: .........................................  Phone  .........................................................

            Address .......................................................   Fax ...............................................................

            PO Box ........................................................   E-mail ..........................................................






            1. Product ....................................................  Other requirements: .....................................
            2. Quantity ...................................................  .....................................................................
            3. REQUIREMENTS:                                     .....................................................................
            -  Charge   pull   push
              Load       static           ...........kg          5. SURFACE:
                         dynamic          ...........kg           Primer
            -  stroke length              ...........mm           painted        RAL-No.: .........................
            -  space/ overall heigth      ...........mm
            -  Accident prevention regulation                     zinc plated
             DGUV 54    DGUV-R 100-2.10      2                    others ......................................................
                        1
               others .....................................................  .....................................................................
            - Temperature range           ...........°C          - Documents / Type plate

            4. DRIVE:                                             english
             manually operated                                   german
             fix crank                                           french
             detachable crank                                     others .......................................................
             foldable crank
               other manual drive   ................................
            .....................................................................
             electric drive
             400 V - AC  230 V - AC  24 V - DC
               h
             ydraulic drive
             pneumatic drive
            -   travel speed..................................
            -   protection class ............................
            -   duty ratio ......................................
                                        y
            -   limit switch          es   no
                                        y
            -   overload protection    es   no



            6. Application:

            (Add Sketch / Drawing / Photo ) ........................................................................................................
            ........................................................................................................................................................

            ........................................................................................................................................................
            1   German Accident Prevention Regulations (DGUV) for winches, lifting- and pulling equipment
            2   German Accident Prevention Regulations (DGUV) for lifting platforms





       28   haacon hebetechnik gmbh  Tel.: + 49 (0) 93 75 / 84-0       DMSZ
                                   Fax: + 49 (0) 93 75 / 84-66
            Josef-Haamann-Str. 6
                                                                       Zertifiziert nach
            D-97896 Freudenberg/Main  hebetechnik@haacon.com           ISO 9001 QM 00414
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