LEG SRL DBL Sala Block Monthly Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date of Inspection:

  Date

• LEG Team Member Conducting Inspection:

• Rig No.

• Location of SALA Block on rig:

• Serial No.

• Model No.

• Lot No.

• Manufacture Date:

• Date of last service:

Inspection:

• Are there any loose or missing bolts and bent or damage parts?

  Yes

  No

  N/A

• Is there any visible distortions, cracks or other damages on the housing?

  Yes

  No

  N/A

• Does the life line pull out and retract fully?

  Yes

  No

  N/A

• Does device lock up when lifeline is jerked sharply? ( Note: Lock up should be positive with no slip.)

  Yes

  No

  N/A

• Is data plate and labels present and fully legible?

  Yes

  No

  N/A

• Are there any signs of corrosion on entire unit?

  Yes

  No

  N/A

• Are there any cuts, kinks, broken wires, corrosion, chemical contact areas, or severely abraded areas on lifeline? (Note: Replace the wire rope assembly if there are six or more randomly distributed broken wires in one lay, or three or more broken wires in one strand in one lay. A "Lay" of wire rope is the length of wire rope it takes for a strand to complete one revolution or twist along the rope.)

  Yes

  No

  N/A

• Is there any visible damage, corrosion on safety hook?

  Yes

  No

  N/A

• Does the hook swivel freely?

  Yes

  No

  N/A

• Has hook been shock loaded?(Note: A red indictor line will be present above safety hook. Hook will also not be able to swivel if unit has been shocked loaded.)

  Yes

  No

  N/A

• Additional Notes:

• Provide pictures of unit:

  Media

• Signature of LEG Team Member Conducting Inspection:

  Sign