Become an Inspector "*" indicates required fields 1. APPLICANT DETAILSFirst Name*Last Name*Street*City*Zip Code*State*StateALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPAPRRISCSDTNTXVIUTVTVAWAWVWIWYMobile Phone*Email Address* Date of Birth* MM slash DD slash YYYY Note: GSCS Inspectors must be at least 25 years or olderCCO ID No.*Note: GSCS Inspectors must hold a current CCO crane inspector certificationWhich of the following CCO Certification Crane Inspector designations do you hold? (check all that apply)Designations Articulating Crane Inspector Mobile Crane Inspector Tower Crane Inspector Overhead Crane Inspector 2. EMPLOYMENTCurrent Employer*Employer’s Street Address*City*Zip Code*State*StateALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPAPRRISCSDTNTXVIUTVTVAWAWVWIWYPrimary Employer Contact*Employer Contact Phone Number*3. EXPERIENCE REQUIREMENT Note: To qualify as an Inspector, an individual must have a minimum of 2,000 hours of documented work experience within a five-year period related to maintaining, inspecting, servicing, repairing, or modifying cranes. Do you attest that you have a minimum of 2,000 hours of documented work experience within a five-year period related to maintaining, inspecting, servicing, repairing, or modifying cranes?Experience Requirement* Maintaining Inspecting Servicing Repairing Modifying Cranes Please attach a current resume or CV evidencing your work experience.Resume* 4. REQUESTED CREDENTIALS Note: To qualify as an Inspector, an individual must have documented work experience relevant to each of the credentials to be held by the Inspector. Which of the following categories do you seek to be credentialed as an Inspector? (check all that apply) For each category checked below, please provide evidence of your relevant work experience in the space provided.All Terrain Crane All Terrain Crane All Terrain Crane EvidenceArticulating Boom Crane Articulating Boom Crane Articulating Boom Crane EvidenceBoom Truck Crane Boom Truck Crane Boom Truck Crane EvidenceCarry Deck Crane Carry Deck Crane Carry Deck Crane EvidenceDiesel Luffing Jib Tower Crane Diesel Luffing Jib Tower Crane Diesel Luffing Jib Tower Crane EvidenceElectric Luffing Boom Tower Crane Electric Luffing Boom Tower Crane Electric Luffing Boom Tower Crane EvidenceHammerhead Tower Crane Hammerhead Tower Crane Hammerhead Tower Crane EvidenceHydraulic Boom Crawler Crane Hydraulic Boom Crawler Crane Hydraulic Boom Crawler Crane EvidenceHydraulic Truck Crane Hydraulic Truck Crane Hydraulic Truck Crane EvidenceLattice Boom All Terrain Crane Lattice Boom All Terrain Crane Lattice Boom All Terrain Crane EvidenceLattice Boom Crawler Crane Lattice Boom Crawler Crane Lattice Boom Crawler Crane EvidenceLattice Boom Truck Crane Lattice Boom Truck Crane Lattice Boom Truck Crane EvidenceRough Terrain Crane Rough Terrain Crane Rough Terrain Crane EvidenceSelf-Erecting Tower Crane Self-Erecting Tower Crane Self-Erecting Tower Crane EvidenceService Truck Crane Service Truck Crane Service Truck Crane Evidence5. PHYSICAL REQUIREMENT Note: Inspectors must meet the fit-for-duty physical requirements applicable to operators who operate the equipment they are inspecting. a. Do you attest that you satisfy the physical requirements applicable to individuals who operate the equipment you plan to inspect?Physical Options* Yes No b. Please attach a copy of a current DOT or similar medical certification card evidencing your compliance with applicable ASME physical standards.DOT or Medical Certification* Expiration Date DD slash MM slash YYYY 6. INSURANCE REQUIREMENT Note: To qualify as an Inspector, an individual must carry General Liability and Professional Liability insurance with at least $1,000,000 per occurrence for inspection-related liability and must disclose whether they carry Umbrella or Excess Liability coverage, which is recommended at $1,000,000 per occurrence but not required.a. Do you attest that you have liability coverage in the minimum liability limit of One Million Dollars ($1,000,000) per occurrence for liability exposures related to the inspection of load handling equipment?Insurance Options* Yes No b. Please attach a copy of your current liability insurance certificate.General Liability Certificate* Expiration Date MM slash DD slash YYYY Professional Liability Certificate* Expiration Date MM slash DD slash YYYY Umbrella/Excess Liability Certificate (if applicable) Expiration Date MM slash DD slash YYYY 7. INDUSTRY STANDARDS All credentialed GSCS Inspectors must be familiar with applicable provisions of OSHA regulations and ASME standards relating to the inspection of load handling equipment. Inspectors are required to own copies of applicable standards relating to the inspections they intend to conduct as credentialed GSCS Inspectors.a. Do you attest that you are familiar with applicable provisions of OSHA regulations and ASME standards relating to the inspection of load handling equipment for the categories in which you seek to be credentialed as a GSCS Inspector?Industry Options* Yes No b. Please check each of the printed standards of which you have a duly licensed copy in your possession (check all that apply). For each standard you have, please identify the year of publication for your licensed version. Note: Copies of the required ASME standard can be purchased here. ASME B30.1 ASME B30.3 ASME B30.5 ASME B30.22 ASME B30.29 ASME B30.30 8. LOCAL REGULATIONS All credentialed GSCS Inspectors must be familiar with applicable provisions of state, municipal, and local regulations and practices relating to the inspection of load handling equipment.Do you attest that you are familiar with applicable provisions of state, municipal, and local regulations and practices relating to the inspection of load handling equipment in the jurisdictions where you plan to conduct inspections as a credentialed GSCS Inspector?Local Regulations Options* Yes No 9. CRIMINAL BACKGROUNDa. Have you ever been convicted of a felony or a crime punishable by over a year in prison (including misdemeanor domestic violence)?Criminal Background Options a* Yes No Please provide detailsb. Do you provide your consent for GSCS to perform a criminal background check, at any time and from time to time during your credential period(s)? Criminal Background Options b* Yes No 10. REFERENCES Please provide two references who can confirm that you are capable of performing the tasks of a GSCS Inspector relating to the inspection of load handling equipment.Reference 1Name*Phone Number*Email Address* Reference 2Name*Phone Number*Email Address* 11. FEES The required fee for this application is $250. This is a flat fee, regardless of the number of categories in which credentialing is sought, and the fee is non-refundable. The fee is due at the time of application and is used to cover administrative costs. The application process is not complete and the application will not be processed until the application fee is paid.12. ATTESTATION I declare that the foregoing statements and those in all required accompanying documentation are true. I understand and agree that my failure to provide accurate and complete information, or abide by the policies and procedures governing GSCS credentials, shall constitute grounds for the rejection of my application, or denial or revocation of my credential(s). I understand that CraneSafe USA, LLC reserves the right to verify any information in this application, or my documented crane-related experience and/or education, or other information pertaining to my GSCS credentials or CCO certifications.
