Title Page
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Conducted on
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Prepared by
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Location
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Name of Installer
Serial Number
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Full Body Harness
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Cows Tail
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3 Metre Ladder Strap
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Ladder Yoke
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Drill Bandolier
PPE
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PPE Bag
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Hard Hat & Built in Visor
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Clip on Ear Defenders
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Eye Bolt
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Harness
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Cows Tail
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3mtr Ladder Strap
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Ladder Yoke
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Drill Bandolier
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High Vis Coat
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Quantity & Size
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High Vis Jumper
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Quantity & Size
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High Vis T-Shirt
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Quantity & Size
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Steel Toe Cap Boots
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Will you have Steel Toe Cap Boots before you start working
Installer Consent
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Do you agree with report details
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What don't you agree with the report?
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Do you take full responsibility for your own equipment?
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Do you understand if you loose or intentionally damage equipment you will pay for replacements
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Name & Signature
