Table 2 – Inspection and Maintenance Log
Inspection Date:
Inspected By:
Components:
Inspection:
(See Section 1 for
Inspection Frequency
)
User
Competent
Person
Rescue Kit
Inspect all components of the Rescue Kit for corrosion or damage such as cracks, bends, dents, or
wear that could affect the strength and operation of the system.
□
□
Inspect all Rescue Kit fasteners. Check for fasteners that may be missing or damaged. All fasteners
should be tight and should not rotate freely.
□
□
Inspect Pulleys and Pulley Release Pins for excessive wear and corrosion. Ensure the Pulley Release
Pins function correctly.
□
□
Verify that all labels are securely attached and are legible (see
‘Labels’
)
□
□
Jib System
Inspect the Jib system per the instructions included with the system.
□
□
PFAS and Other
Equipment
Additional Personal Fall Arrest System (PFAS) equipment (harness, SRL, etc.) that are used with
the Flexiguard System should be installed and inspected per the manufacturer’s 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:
Corrective Action/Maintenance:
Approved By:
Next Inspection Due:
Date:
Corrective Action/Maintenance:
Approved By:
Next Inspection Due:
Date:
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