Title Page

  • Document No.

  • SRL Serial no

  • SRL ISM no

  • Client / Site / area

  • SRL manufacturing date

  • SRL ISM date

  • SRL next ISM date

  • Conducted on

  • Prepared by

  • Location Gps
  • Personnel note

  • SRL Brand

  • Specify if other

  • Model

  • Length of SRL cable

External inspection

  • Housin

  • Housing Screws

  • Function test

  • Cable (Any Pinch points; Rust; Broken Strands; etc)

  • Safety hook / fall indicator (Deformed; Rust; Activated; Etc)

  • Handle

  • Handle screws

Internal inspection

  • Cable roller guide

  • Axle bearing

  • Paws and Paws spring

  • Main spring

  • Brake adjustment 75-80Nm torque

  • Brake pads

  • Centrifugal brake

  • Brake pads 61.5mm - 57.5 mm

  • Tooth and break ring


  • Site manager

  • Technician


  • Is the SRL SAFE for use after inspection

  • Level of ISM Done

  • Notes

Final Results:

  • Is the SRL SAFE for use after required components has been replaced?


  • 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

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