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Table 2 – Inspection and Maintenance Log
Inspection Date:
Inspected By:
Components:
Inspection:
(See Section 1 for
Inspection Frequency
)
User
Competent
Person
1
Perimeter Limiter
(Figure 2)
Inspect the Perimeter Limiter for damage: Look for cracks, dents, or deformities.
Inspect the entire unit for corrosion.
Labels (Figure 11)
Verify that all labels are securely attached and are legible (see
‘Labels’
)
PFAS and Other
Equipment
Additional Personal Fall Arrest System (PFAS) equipment (harness, SRL, etc) that are used with
the Flexiguard Anchorage 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:
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.
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