3M 2103143 Mode D'emploi page 13

Inspection Date:
Components: Inspection:
Trolley Anchor Inspect Trolley for damage. Look for cracks or deformation. Look for excessive wear
(Figure 2) or damage to the anchorage connection point. All fasteners must be secure.
Inspect the Trolley Wheels. All wheels should turn freely and be undamaged.
Inspect the entire unit for corrosion.
Ensure the Clevis Pin (G) can be inserted through the holes in the Support Tube
(A). Ensure both the Clevis Pins are installed in the Support Tube and that both Key
Rings are fully secured. Only use the provided Clevis Pins with the Trolley Anchor.
Inspect already-installed Trolley Anchors and confirm they are installed correctly
per Section 3.
Structure Verify the structure meets the requirements of Table 2, the beam has the end stops
at each end of the beam, and the beam is undamaged in any way.
Labels (Figure 12) Verify that all labels are present and fully legible.
Fall Protection Additional Fall Protection equipment used with the system should be installed and
Equipment inspected per the manufacturer's instructions.
Serial Number(s):
Model Number:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Table 3 – Inspection and Maintenance Log
Inspected By:
(See Section 1 for Inspection Frequency)
Date Purchased:
Date of First Use:
Approved By:
Date:
Approved By:
Date:
Approved By:
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Approved By:
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Approved By:
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Approved By:
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Approved By:
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Approved By:
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Approved By:
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Approved By:
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Approved By:
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Approved By:
Date:
Approved By:
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Approved By:
Date:
Competent
User Person
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