3M DBI-SALA EZ-Stop AJ512Y/0 User Instructions page 20

Serial Number(s):
Model Number:
Inspected By:
Component: Inspection:
Carabiners Inspect Snap Hooks, Carabiner, Rebar Hooks, etc. for signs of damage, corrosion, and proper
Hooks working condition. Where present: Swivels (A) should rotate freely, and Carabiner and Hook Gates
(Figure 15) (B) should open, close, lock, and unlock properly. Inspect Rope Grabs (C) per the instructions
included with the Rope Grab or Vertical Lifeline.
Web Lanyards Inspect webbing; material must be free of cuts (A), frays (B), or broken fibers. Check for tears,
Webbing and Stitching abrasions, heavy soiling (C), mold, burns (D), or discoloration. Inspect stitching; Check for pulled
(Figure 16) or cut stitches. Broken stitches may be an indication that the harness has been impact loaded and
must be removed from service.
Rope Lanyards Inspect the rope, material must be free of frayed strands, broken yarns, cuts, abrasions, burns,
Rope and Thimbles discoloration, chemical or heat damage (indicated by brown, discolored, or brittle areas), and
(Figure 17) ultraviolet damage (indicated by discoloration and the presence of splinters and slivers on the rope
surface). The rope must be free of knots, excessive soiling, heavy paint buildup, and rust staining.
Rope splices must be tight, and thimbles must be held by the splice. Cracked or distorted rope
thimbles may indicate that the Rope has been impact loaded. Damaged or questionable ropes must
be removed from service.
Energy Absorber Verify that the integral Energy Absorber has not been activated. An open cover (A) or torn cover
(Figure 18) (B), webbing pulled out of the cover (C), torn or frayed webbing (D), and ripped or missing
stitching (E) are indicators of an activated Energy Absorber.
Labels (Figure 20) All labels should be present and fully legible.
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 1 – Inspection & Maintenance Log
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:
Date Purchased:
Date of First Use:
Inspection Date:
Periodic examination next due
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Periodic examination next due
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Periodic examination next due
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Periodic examination next due
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Periodic examination next due
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Periodic examination next due
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Before Competent
Each Use Person