Inspection Date:
Components:
Inspection:
Davit System
Inspect all structural parts for damage including dents, cracked welds, bent, or crushed
tubes.
Inspect all hardware (pins, tri-screws, adjuster screws, nuts, bolts, pulleys, rollers, and
winch brackets) for damaged threads, bent, damaged or missing fasteners, or loose
fasteners. Check all pulleys and rollers for chips, grooves, and excessive wear. Ensure that
all pulleys and rollers turn freely.
Labels (Figure 14)
Verify that all labels are securely attached and are legible.
Fall Protection
Additional Fall Protection system equipment (harness, SRDs, winches, etc) that are used
with the System should be installed and inspected per the manufacturer's instructions.
system and Other
Equipment
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:
1 Competent Person:
One who is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary,
hazardous, or dangerous to employees, and who has authorization to take prompt corrective measures to eliminate them.
Table 3 – Inspection and Maintenance Log
Inspected By:
(See Section 1 for Inspection Frequency)
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
1
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: