Table 2 – Inspection and Maintenance Log
Inspection Date:
Inspected By:
Components:
Inspection:
(See Section 1 for
Inspection Frequency
)
User
Competent
Person
Concrete Bolt Anchor
(Figure 2)
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 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 (D) must be
seated firmly against the concrete.
Inspect the D-Ring (C) for damage or corrosion. Inspect the D-Ring for cracks or
wear that may affect strength and operation.
Inspect the D-Ring Bracket (D) 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.
Labels (Figure 11)
Verify that all labels are securely attached and fully legible.
Structure
Verify that the concrete structure and hole meet the requirements of Table 1.
Verify that the concrete is free of any cracks or damage.
Fall Protection
Equipment
Additional Fall Protection equipment that is used with the system should be
installed and inspected per the manufacturer instructions.
Serial Number(s):
Date Purchased:
Model Number:
Date of First Use:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
Corrective Action/Maintenance:
Approved By:
Next inspection due:
Date:
