Title Page

  • Document No.

  • Serial Number

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Type of Anchor point

  • Fixing anchor to material

  • Brand/Model of Anchor point

  • Anchor Type

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


  • Date of installation

  • Last date of Inspection

  • Is all the labels and certification in place and readeble

  • SWL 150kg

Installer's Details:

  • Installations Manager

  • Installer on site


  • Is the systen safe for use

  • Notes


  • 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.
    +27 (0) 12 804 0567


The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.