3M DBI SALA 2104565 Manual Del Usuario página 11

Inspection Date:
Components: Inspection:
Concrete Bolt Anchor Inspect the Concrete Bolt Anchor for damage: Inspect the torque seal. If the green seal on
the bolt head is damaged or missing, the Concrete Bolt Anchor may not be properly installed
(Figure 2)
or may have been tampered with. Any Concrete Bolt Anchor that shows signs of tampering
must be removed from service. It may not be used for fall arrest, fall restraint, work
positioning, or rescue applications.
Inspect the anchor for proper embedment. The D-ring bracket must be seated firmly against
the concrete.
Inspect the D-ring for damage or corrosion. Inspect the D-ring for cracks or wear that may
affect strength and operation.
Inspect the D-ring bracket for damage or deformation. The bracket should swivel freely on
the bolt. Inspect the bracket for cracks or wear that may affect strength and operation.
Inspect the system components according to the manufacturer's instructions.
Labels (Figure 11)
Verify that all labels are securely attached and are legible (see 'Labels').
Verify that the concrete structure and hole meet the requirements of Table 1. Verify that the
Structure
concrete is free of any cracks or damage.
PFAS and Other Additional Personal Fall Arrest System (PFAS) equipment (harness, SRL, etc) that are
used with the Anchorage System should be installed and inspected per the manufacturer's
Equipment
instructions.
Serial Number(s):
Model Number:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
1 Competent Person:
One who is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary,
hazardous, or dangerous to employees, and who has authorization to take prompt corrective measures to eliminate them.
Table 2 – Inspection and Maintenance Log
(See Section 1 for Inspection Frequency)
Inspected By:
Date Purchased:
Date of First Use:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Competent
User Person
1