INNO
TECH
SAFETY SOLUTIONS
Arbeitsschutz GmbH
Edition 04/01/2007
SERVICE FORM
(COPY TEMPLATE - A4)
I N S P E C T I O N L O G I
PROJECT:
PRODUCT:
MANUFACTURING NO.:
ANNUAL SYSTEM INSPECTION EXECUTED ON:
INSPECTION POINTS:
checked and in order!
DEFECTS DETECTED:
(Description of defect / measures)
DO C U M E NT AT IO N :
Instructions for installation and use
Acceptance log
Dowel log
Photo documentation
P P E (p e rs o n al p ro t ec t i v e e qu i pm e nt ag a i n st f a l l i ng ) :
I ns p ec t i on i n ac c o rd a nc e w it h m a nu f ac t u r e r' s s pe c i f ic a t i on s
Expiration date
Annual inspection performed
Not checked (no authorization)
A N CH O R A G E P O I N T I NN O T E CH LO C K- 13
No deformation
The attachment eye can rotate
No corrosion
Threaded joints secured
Spring function
RE C E P T A CL E SL E E VE I N NO T E CH LO CK - 1 1 :
No fouling
No corrosion
Firm seat
Acceptance result:
The safety system corresponds to the specifications in the manufacturer's instructions for
installation and use and the state of the art. Technical safety reliability is confirmed.
Comments:
Expert who is familiar with the safety system:
NAME:
SIGNATURE:
