Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Date of Inspection:

  • 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?

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

  • Does the life line pull out and retract fully?

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

  • Is data plate and labels present and fully legible?

  • Are there any signs of corrosion on entire unit?

  • 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.)

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

  • Does the hook swivel freely?

  • 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.)

  • Additional Notes:

  • Provide pictures of unit:

  • Signature of LEG Team Member Conducting Inspection:

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