Anchor point Report

• Document No.

• Serial Number

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Type of Anchor point

• Fixing anchor to material

  Steel structure

  Concrete

  Brick

  Other

• Brand/Model of Anchor point

• Anchor Type

  Media

Testing Equipment

• All nuts and bolts are secured and torqued to 70Nm

• Is the Hydra Jaw pull tester used for testing the anchor that is installed into Concrete, Brick etc. I here by acknowledge that I have tested each Anchor point as to the aproved SOP. New installation 12Kn for 3 min Inspection. 6 Kn for 1 min

Signs

• Date of installation

  Date

• Last date of Inspection

  Date

• Is all the labels and certification in place and readeble

  Yes

  No

  N/A

• SWL 150kg

Installer's Details:

• Installations Manager

  Sign

• Installer on site

  Sign

Results

• Is the systen safe for use

  Safe

  At Risk

  N/A

• Notes

Disclaimer

• Evolution Height Safety will not accept responsibility or liability for failure of an installed system or component of a system in the following instances:
  
  A. Failure is as a result of an act of God.
  B. The failure took place after the expiry date of the system.
  C. The maximum number of persons that the system was certified for was exceeded.
  D. The system was used for purposes other than a fall arrest anchor for human beings.
  E. The system was used after being subjected to a major fall or excessive load without being examined by a EHS approved and competent person and subsequently being re-certified as being safe for its intended purpose
  
  Contact details:
  Evolution Height Safety Pty Ltd.
  www.evolutionsafety.co.za
  Info@evolutionsafety.co.za
  +27 (0) 12 804 0567
  
  http://www.evolutionsafety.co.za