Inspection Date:
Components:
Inspection:
Roof Anchor
Inspect the Roof Anchor for physical damage. Look carefully for any signs of cracks,
(Figure 2)
dents or deformities in the metal. Check for bending, the roof anchor side plates
(E) should be flat. Rivets (B) should be securely attached and fully clinched (not
pulling through hole). Inspect chain (G) and O-Ring (K) for damage.
Ensure the Roof Anchor is still securely attached. If loose, do not use.
Inspect the entire unit for corrosion.
Ensure the condition of the roof will support the Roof Anchor loads, see section 2.1. An anchor
connected to rotted or deteriorated wood should not be used.
Labels (Figure 13)
Verify that all labels are securely attached and are legible (see 'Labels')
PFAS and Other
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
Equipment
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:
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.
Table 2 – Inspection and Maintenance Log
Inspected By:
(See Section 1 for Inspection Frequency)
User
Date Purchased:
Date of First Use:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Competent
Person
1