Title Page
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Document No.
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Serial number
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Type of system
- Combi line
- Alti line
- Alti line rooftop
- Uni 8
- Uni 8 OH
- Uni 16
- Roof-safe
- Evolution system
- Other system please specify
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Brand and type of System
1. Wire rope
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Length of system. M
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Is the stainless steel 316L wire rope 7x7 - 8mm safe for use?
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Is the stainless steel 316L wire rope 1 x 19 - 8mm safe for use?
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Strands
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Wear and tear of the wire rope at the intermediate support bracket(s) / corner(s) / joiner(s)
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Oxidation
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Flexibility
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Any obstructions against the cable that is not planned <br>Please specify
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Situated close to corrosive environment (chlorine.....)
2. Fixed end supports
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Is the swage points swage according to SOP
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Is the Hydra Jaw pull tester used for testing the crimped components I here by acknowledge that i have tested each component as to the SOP New installation 12Kn for 3 min Inspection. 6 Kn for 1 min
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Is the shock absorber(s) intact and safe for use?
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Tension indicator correctly tensioned and safe for use.
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Is the anchor points and structure safe for the system setup?
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Pretension (correct tension)
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Fall indicator ( Not activated)
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Axis and pin
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Positioning , spacing and tightening of the G-clips
3. Intermediate supports
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Any damaged, broken, deformed, corrosion, missing etc. Intermediate support(s) <br>Please specify !
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Is the spacing between supports as per designed system<br>Normal 1-15m max
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Is the spacing between supports as per designed system<br>Normal 1 -30m max<br>OH
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Is the spacing between supports as per designed system<br>Normal 1-50m max<br>OH specialized
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Tightening of bolt and nut M12
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Tightening of bolt and nut positioning support M8<br>Plastic or steel?
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Anchor into concrete
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L Bracket support(s)
4. Post anchors e.g roof-safe or std post for concrete
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Is the roof post EC at the End/CORNER in place
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Post Shock absorber
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Is the roof post INT in place only at max 12m intermediate spacing
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Is the correct fastening method used
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Std post
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Is the chemical anchors tested and certified to EN 795 : 2012 for post
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Is the Hydra Jaw pull tester used for testing the anchor components I here by acknowledge that i have tested each component as to the SOP New installation 12Kn for 3 min Inspection. 6 Kn for 1 min
5. Corner supports
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Is the corner supports in a safe conditions and all bolts fixed securely <br>or <br>at Risk E.g bend, broken, rusted, deformed, missing components etc.<br>Please comment
6. Runners
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Functioning of cams
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Wear and tear
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Is the mobile shuttle compatible with corner, cable, intermediate support or use with SRL?
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Is the mobile shuttle(s) moving freely over the cable, intermediate support(s) or corner(s)
7. Signs
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Date of installation
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Last date of inspection done
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Number of user(s) allowed
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Is all the labels and certification in place and readeble
8. Installer details
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Installation manager
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Installer on site
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Lifeline safe for use
- Safe for use
- Not safe for use
- Needs new components
- Replace lifeline ASAP
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Comments
9. Disclaimer
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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
