3M 2104560 Manual Del Usuario página 11

Inspection Date:
Components: Inspection:
Concrete Bolt Anchor Inspect the Concrete Bolt Anchor for damage: Inspect the torque seal. If
(Figure 2) the green seal on the bolt head is damaged or missing, the Concrete Bolt
Anchor may not be properly installed or may have been tampered with. Any
Concrete Bolt Anchor that shows signs of tampering must be removed from
service. It may not be used for fall arrest, fall restraint, work positioning, or
rescue applications.
Inspect the anchor for proper embedment. The D-Ring Bracket (D) must be
seated firmly against the concrete.
Inspect the D-Ring (C) for damage or corrosion. Inspect the D-Ring for cracks or
wear that may affect strength and operation.
Inspect the D-Ring Bracket (D) for damage or deformation. The bracket should
swivel freely on the bolt. Inspect the bracket for cracks or wear that may affect
strength and operation.
Labels (Figure 11) Verify that all labels are securely attached and fully legible.
Verify that the concrete structure and hole meet the requirements of Table 1.
Structure
Verify that the concrete is free of any cracks or damage.
Fall Protection Additional Fall Protection equipment that is used with the system should be
Equipment installed and inspected per the manufacturer instructions.
Serial Number(s):
Model Number:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Table 2 – Inspection and Maintenance Log
(See Section 1 for Inspection Frequency)
Inspected By:
Date Purchased:
Date of First Use:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Competent
User Person
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due:
Next inspection due: