3M PROTECTA ANSI Z359.18 Manuel D'instructions page 13

Inspection Date:
Components: Inspection:
Tie-Off Adapter Inspect the hardware for damage: Check the Snap Hook (C), O-Ring Connector (D),
Carabiner (E), and D-Ring (F) for cracks, dents, and deformities.
(Figure 2)
If applicable, inspect the Web Lifeline (B) for damage. The webbing must be free of
frayed, cut, or broken fibers. Check for tears, abrasions, mold, or discoloration. The
webbing must be free of knots, excessive soiling, heavy paint build-up, and rust staining.
Check for chemical or heat damage, indicated by brown, discolored, or brittle areas.
Check for ultraviolet degradation, indicated by discoloration and slivers or splinters on
the webbing surface.
If applicable, inspect the Web Lifeline for pulled or cut stitches. Broken stitches may be
an indication that the Tie-Off Adapter has been impact loaded and must be removed
from service.
Inspect the entire unit for corrosion.
If applicable, inspect the Cable Lifeline (A) for damage. Inspect the cable for cuts,
kinks, broken wires, bird-caging, corrosion, welding splatter, chemical contact areas, or
severely abraded areas. Inspect ferrules for cracks or damage.
Labels (Figure 11) Verify that all labels are present and fully legible.
Additional Personal Fall Arrest System (PFAS) equipment (harness, SRD, etc) that
PFAS and Other
are used with the Anchorage System should be installed and inspected per the
Equipment
manufacturer's instructions.
Verify the structure to which the anchor is attached meets the strength requirements
Structure
from Table 1 in all possible directions of loading. The structure must be free of any
damage.
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:
Table 2 – Inspection and Maintenance Log
Inspected By:
(See Section 1 for Inspection Frequency)
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:
Competent
User Person
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: