ROTHOBLAAS TOWER Manuel D'utilisation page 27

DICHIARAZIONE DI CORRETTA INSTALLAZIONE DISPOSITIVI ANTICADUTA STATEMENT OF CORRECT INSTALLATION OF FALL PROTECTION DEVICES
With regard to the installation of the anchor devices for protection against falls installed on the building located in:
Address:
City :
The undersigned:
First name:
Legal representative of the company:
Address of head office:
City:
EN 795
Type A
*
Type C
*
Type D
*
Type E
*
Fastening element Sub-base size/quality
have been correctly installed as per the indications of the manufacturer and
The anchor devices have been positioned on the roof as per the attached plan prepared by:
Architect/Engineer/Surveyor
according to the instructions provided in the calculation report prepared by:
Architect/Engineer/Surveyor
The characteristics of the anchor device(s), the instructions regarding
their correct use, the inspection sheets have been filed with:
*
the owner of the building
*
the building manager
The notice-plate for fall protection systems is posted:
*
Near every roof access point
*
Date of first system start-up:
Date:
The owner shall keep the equipment installed in good working condition in order to maintain the necessary solidity and resistance in time.
Maintenance shall be performed by qualified personnel and carried out according to the procedures and time schedules indicated by the manufacturer.
Last name:
Declares that the devices
Quantity Model
Installation depth
[mm]
as per the provisions of standard EN 795
The Installer (stamp and signature):
No.:
Postal Code:
No.:
Postal Code:
Manufacturer
Ø Hole
[mm]
Date of first inspection:
Prov.:
Prov.:
Serial No./Year
Tightening torque
[Nm]
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