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Anchorage Connectors Inspection Form
Manufacturer:
*
Owner/Company:
*
Model:
*
Description:
Serial:
*
Lot:
*
Date of Manufacture:
*
Other:
Anchor Material:
Galvanized Steel
Zinc-plated steel
Stainless Steel
Aluminum
web
Labels & markings
Label (Intact & Legible)
Pass
Fail
N/A
Appropriate ANSI/OSHA/CSA Markings
Pass
Fail
N/A
Inspections are Current / Up-to-Date
Pass
Fail
N/A
Date of First Use
Pass
Fail
N/A
Hardware (if Applicable)
Signs of Deformity
Pass
Fail
N/A
D-Ring / Connection Points
Pass
Fail
N/A
Hook Gate / Rivets (if applicable)
Pass
Fail
N/A
Corrosion / Pitting / Nicks
Pass
Fail
N/A
Aanchorage connector
Termination (Stitch, Splice, or Swage)
Pass
Fail
N/A
Deterioration / Corrosion
Pass
Fail
N/A
Cuts / Burns / Holes
Pass
Fail
N/A
Integrity of Welds / Rivets
Pass
Fail
N/A
Paint Contamination
Pass
Fail
N/A
Stitching / Wire Condition
Pass
Fail
N/A
Heat Corrosion / UV Damage
Pass
Fail
N/A
Separation / Bird-Caging
Pass
Fail
N/A
Notes:
Foreman Name:
Project Name:
Name of Inspector:
*
Date of Inspection:
*
Employee ID:
*
In-Service Date:
Print Name:
*
Signature:
*
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Foreman Email:
Other Email:
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