General Information

  • Test Carried Out By:

  • Date Test Carried Out:

  • Purpose Of Test

  • Test Requested By:

  • Anchors Installed By:

Anchor Details*

  • Anchor Manufacturer

  • Anchor Type, Size and Finish

  • Purpose Of Anchor

  • Characteristic Resistance

  • Design Resistance

Test Details

  • Type Of Loading

  • Proof or Allowable Resistance

  • Required Proof Loading

  • Description:

  • Result:

  • Test Result Comments:

  • Signature:

  • Supporting Photo's

Testing Location

  • Location

  • Anchor Reference

  • Edge Distance

  • Centre Spacing

Base Material

  • Material Type / Strenght

  • Thickness

Installation Details*

  • Hole Diameter

  • Drill Bit Cutting Diameter

  • Hole Depth

  • Resin Type

  • Embedment Depth

  • Hole Cleaning Method

  • Temperature When Installed

  • Manufacturer Curing Time

  • Actual Curing Time Allowed

Test Equipment

  • Hydraulic Jack

  • Hydraulic Pump

  • Pressure Gauge

  • Measurement Gauge

  • Anchor to Support Distance

  • *All Details were provided by Client and we're not measured on site.

Drawings

Location Drawings

Certificates

Certificates

Extra Test

  • Location:

  • Description:

  • Pass/Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comment:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

  • Location:

  • Description:

  • Pass / Fail

  • Test Result Comments:

  • Supporting Photo's

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.