3M DBI SALA Door Jamb Anchor Manuel D'instructions page 11

Inspection Date:
Components: Inspection:
Door Jamb Anchor Inspect the Door Jamb Anchor for damage: Look for cracks, dents, or deformities. Look for
bending or wear on the support tube, D-ring, and adjustment mechanisms. Ensure no parts are
(Figure 2)
loose or missing.
Inspect the adjustment mechanisms. The coarse adjustment pin must lock when inserted
through any of the adjustment holes.
Inspect entire unit for excessive corrosion. Inspect the torque on the fine adjustment screw and
tighten if necessary.
Labels (Figure 10)
Verify that all labels are securely attached and are legible (see 'Labels')
Anchor Structure
Inspect the door frame, window, and/or structure to make sure it is all load bearing and meets
the strength requirements from Table 1.
PFAS and Other Additional Personal Fall Arrest System (PFAS) equipment (harness, SRL, etc) being used with
the Flexiguard 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:
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
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:
Competent
Person
1