4
Inspection Date
Inspection Items Noted
Corrective Action
Maintenance Performed
Approved By:
Approved By:
Approved By:
Approved By:
Approved By:
Approved By:
Approved By:
Approved By:
EXAMPLE OF TAGS
FOR DROPS GREATER THAN 6’
ANSI/ASSE Z359.1
MATERIAL: NYLON / POLYESTER ENERGY
ABSORBER. ARRESTING FORCE 900 LBS.
TO 1800 LBS MAX PLUS 52” MAXIMUM EXTENSION. RIG
LANYARD TO ALLOW A MAXIMUM FREE FALL DISTANCE
OF NOT MORE THAN 12’ OR TO CONTACT A LOWER
LEVEL.
CONNECTORS AND ANCHORAGE POINTS MUST BE
COMPATIBLE AND ABLE TO SUPPORT M.B.S. 5000 LBS.
DO NOT ALLOW SYNTHETIC LANYARD TO CONTACT
SHARP OR ABRASIVE SURFACES, SPARKS OR
TEMPERATURES ABOVE 180 DEGREES.
SNAP HOOKS WITH GATE OPENINGS LARGER THAN 1”
MUST NOT BE CONNECTED TO D-RINGS ON HARNESSES
AND BELTS.
REMOVE FROM SERVICE IF ANY DAMAGE IS DETECTED.
WARNING
MANUFACTURER’S INSTRUCTIONS SUPPLIED WITH THIS
PRODUCT AT TIME OF SHIPMENT MUST BE FOLLOWED.
FAILURE TO DO SO COULD RESULT IN SERIOUS INJURY
AND/OR DEATH.
DO NOT EXPOSE TO CHEMICALS AND CORROSIVES
WHICH WOULD WEAKEN MATERIALS AND HARDWARE,
CONSULT MANUFACTURER, IF IN DOUBT.
CONTACT MANUFACTURER IF INSTRUCTIONS ARE
NEEDED.
ULTRA-SAFE, INC.
MANUFACTURED IN THE U.S.A.
S
E
R
IA
L
N
O
.
L
2
4
8
5
9
5
D
A
T
E
I
N
IT
IA
L
S
IN
S
P
E
C
T
IO
N
C
H
A
R
T