Inspection Date:
Components:
Inspection:
Rescue Kit
Inspect all components of the Rescue Kit for corrosion or damage such as cracks, bends, dents, or
wear that could affect the strength and operation of the system.
Inspect all Rescue Kit fasteners. Check for fasteners that may be missing or damaged. All fasteners
should be tight and should not rotate freely.
Inspect Pulleys and Pulley Release Pins for excessive wear and corrosion. Ensure the Pulley Release
Pins function correctly.
Labels (Figure 5)
Verify that all labels are present and fully legible.
Jib System
Inspect the Jib system per the instructions included with the system.
Fall Protection
Additional Fall Protection equipment that is used with the product should be installed and inspected
Equipment
per the manufacturer 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:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Table 2 – Inspection and Maintenance Log
(See Section 4 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:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Competent
User
Person
□
□
□
□
□
□
□
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Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due: