3M DBI-SALA Mobi-Lok 2200094 Manuel D'instruction Pour L'utilisateur page 14

Inspection Date:
Components: Inspection:
Vacuum Anchor Inspect the Vacuum Anchor for damage. Look for cracks, dents, or deformities. Look for
bending or wear on the Base (A), Housing (B), Vacuum Hoses (F, K, L), Connectors (E, J),
(Figure 2)
Carrying Handle (M), and D-Ring (C).
Inspect the entire unit for corrosion.
Inspect Vacuum Pads (I) for wear, tears, and cracking. On the Pad underside, inspect the air
filter for contamination. Replace as needed.
Labels (Figure 9
Verify that all labels are securely attached and are legible (see 'Labels').
and Figure 10)
PFAS and Other Additional Personal Fall Arrest System (PFAS) equipment (harness, SRL, etc) that are used with
the Anchorage System should be installed and inspected per the manufacturer's instructions.
Equipment
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:
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)
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:
Approved By:
Date:
Competent
User Person
1
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due: