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© Copyright 2012, Alcor Inc.
Produced in collaboration with Technical Training & Compliance
INSPECTION CARD
Pre-use and inspection form for
GRIZZLY
861000 Hercules mobile anchoring
system
Please
make
copies
of
this
form
and
complete
it
before
each
use
in
two
copies.
A completed form must follow the Hercules mobile anchoring system on site and the other is for your records.
Users must review this form prior to use.
SERIAL #: ____________________________
INSPECTION DATE: _________________________
ADDRESS OR PROJECT NAME: __________________________________________________________________
HEIGHT BETWEEN THE PLACE THE HERCULES WILL BE POSITIONED AND THE GROUND OR ANY OBSTACLE
: ___________
Safe distance for fall should be calculated by a competent person before use and should comply with all local
regulations.
Travel restraint is always preferred over fall arrest.
Yes
No
Does this project allow the use of the mobile anchoring system in fall arrest mode
?
Comment : ___________________________________________________________________________________
Inspection :
Conform
Conform
Yes
No
Yes
No
Welds
General condition
Anchors
Lifting rings
Pivot arms
Stickers
Jacks
Corrosion
Wheels
Other
If non-compliance is noted, please label "Dangerous - Out of Order" and have unit repaired before reusing.
Signed: _______________________________ Name (bloc letters): ____________________________________
