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E02 bo Indice 1 du 01 07 09 ENERGY ABSORBER PPE Inspection form p a

E02 bo Indice 1 du 01 07 09

ENERGY ABSORBER

PPE Inspection form

page 1/2

User:

Company name:

Model:

Company address:

Serial No: (batch number)

Unique ID: (your marking)

Year of manufacture:

Comments:

Date of first use:

Date of purchase:

The inspection of this product should be done with the manufacturer technical notice

Historical Check :

The results of this PPE inspection are provided to you subject to the condition that the components to be inspected do not come into any of the categories listed below, any of which would require systematic rejection of the component, namely:

- Component has undergone modification or alteration outside the manufacturer’s production units.

 

- Component has received forces from a fall of factor 1 or more.

- Component has been used in temperatures of less than -40 ºC or greater than +80 ºC.

 

- Component has exceeded it’s lifetime.

- The product has been in contact with chemicals.

The inspector accepts no responsibility in the case of omission or inaccuracy in the information concerning the checking of the components history, which must be done by the client.

 

Visual check of safety components

C

G

TM

TR

R

Condition of the rope (cuts, wear, burns, marks, chemical contamination, soft spots)

         

Condition of the webbing (cuts, wear, burns, marks, chemical contamination)

         

Condition of load-bearing stitching (cut, worn, torn or pulled threads)

         

Condition of metal pieces (deformation, marks, cracks, wear, corrosion)

         

Check of comfort components

C

G

TM

TR

R

Condition of the protection components (string, stitching protectors, protective cover)

         

Compatibility check

C

G

TM

TR

R

Condition and compatibility of the connector (see connector form)

         

C: Comment (see below) / G: Good / TM: To Monitor / TR: To Repair / R: Reject

Comments :

Verdict (tick)

This product is fit to remain in service (PASS)

 

This product is unfit to remain in service (FAIL)

Date of inspection:

 

Date of next inspection:

 

Inspected by: (name)

 

on behalf of: (company)

Signature:

 
SPORTS ENERGY ABSORBER

SPORTS ENERGY ABSORBER

E02 br Index 1 dated 16 11 09

PPE inspection form

User:

Name:

Model:

Address:

Serial No (batch No):

Unique ID (your marking):

Year of manufacture:

Comments:

Date of first use:

Date of purchase:

The inspection of this product should be done together with the manufacturer’s instructions for use.

Historical check:

The results of this PPE inspection are provided subject to the condition that the components to be inspected do not belong to the categories listed below, in which case they must be systematically rejected:

- Component that has undergone modification or alteration outside the manufacturer’s production units.

 

- Component that has received a serious impact.

- Product that has been used in temperatures below -40 °C and above +80 °C.

- Product that has exceeded the manufacturer’s given lifetime.

- The product has been in contact with chemicals.

The inspector accepts no responsibility in case of omission or inaccuracy in the information concerning the historical check which must be carried out by the customer.

Visual check of safety components:

C

G

TM

TR

R

Condition of the energy absorbing part (cut, torn, pulled, worn, deployed)

         

Condition of the webbing (cut, wear, burn mark)

         

Condition of the rope (cut, general wear, hard point, soft point, burn mark)

         

Condition of the metal part (mark, corrosion)

         

Check of comfort components:

C

G

TM

TR

R

Condition of the protection elements (strings, stitching protections, protective cover)

         

Condition of the connection-webbing elasticity

         

Compatibility check:

C

G

TM

TR

R

Condition and compatibility of the type-K connectors (see connector form)

         

C: Comment (see below) / G: Good / TM: To be Monitored / TR: To be Repaired / R: Reject

Comments:

Verdict (tick):

This product may remain in service.

 

This product may not remain in service.

Date of inspection:

 

Date of next inspection:

 

Inspected by:

 

Company:

Signature:

 

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