Evolution height safety ISM SRL

• Document No.

• SRL Serial no

• SRL ISM no

• Client / Site / area

• SRL manufacturing date

  Date

• SRL ISM date

  Date

• SRL next ISM date

  Date

• Conducted on

  Date

• Prepared by

• Location Gps
  Address

• Personnel note

• SRL Brand

  Select 3M Ikar Haru

  • 3M
  • Ikar
  • Haru

• Specify if other

• Model

• Length of SRL cable

External inspection

• Housin

  Safe

  At Risk

  N/A

• Housing Screws

  Safe

  At Risk

  N/A

• Function test

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Handle

  Safe

  At Risk

  N/A

• Handle screws

  Safe

  At Risk

  N/A

Internal inspection

• Cable roller guide

  Safe

  At Risk

  N/A

• Axle bearing

  Safe

  At Risk

  N/A

• Paws and Paws spring

  Safe

  At Risk

  N/A

• Main spring

  Safe

  At Risk

  N/A

• Brake adjustment 75-80Nm torque

  Safe

  At Risk

  N/A

• Brake pads

  Safe

  At Risk

  N/A

• Centrifugal brake

  Safe

  At Risk

  N/A

• Brake pads 61.5mm - 57.5 mm

  Safe

  At Risk

  N/A

• Tooth and break ring

  Safe

  At Risk

  N/A

Sign

• Site manager

  Sign

• Technician

  Sign

Report

• Is the SRL SAFE for use after inspection

  Yes

  No

  N/A

• Level of ISM Done

  Select Level 1 ISM Level 2 ISM - with replaced components as needed Level 3 - Major service Replace all coponents Level 4 - Replace SRL

  • Level 1 ISM
  • Level 2 ISM - with replaced components as needed
  • Level 3 - Major service Replace all coponents
  • Level 4 - Replace SRL

• Notes

Final Results:

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

  Yes - safe for use after Level 1 service

  Yes - safe for use after Level 2 repairs

  No - awaiting authorization

  No - SRL to be replaced

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