Inspection Date:
Components:
Inspection:
Mounting Bracket
Inspect the Mounting Bracket for cracks, dents, or deformities.
(Figure 2)
Inspect the entire unit for corrosion.
PFAS and Other
Additional Personal Fall Arrest System (PFAS) equipment (harness, SRL, etc) that are
used with the Tripod Mounting Base and Bracket should be installed and inspected per the
Equipment
manufacturer's 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 3 – Inspection and Maintenance Log
Inspected By:
(See Section 1 for Inspection Frequency)
User
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
Person
1