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ENERGY ABSORBER

E02 bo Indice 1 du 01 07 09 User: Model: Serial No: (batch number) Year of manufacture: Date of first use:

PPE Inspection form


Company name: Company address: Unique ID: (your marking) Comments: Date of purchase:

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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 manufacturers production units. - Component has received forces from a fall of factor 1 or more. - Component has been used in temperatures of less than -40 C or greater than +80 C. - Component has exceeded its 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


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)

TM TR

Check of comfort components


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

C C

G G

TM TR TM TR

R R

Compatibility check
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) Date of inspection: Inspected by: (name) Signature: This product is unfit to remain in service (FAIL) Date of next inspection: on behalf of: (company)

SPORTS ENERGY ABSORBER


E02 br Index 1 dated 16 11 09 User: Model: Serial No (batch No): Year of manufacture: Date of first use:

PPE inspection form


Name: Address: Unique ID (your marking): Comments: Date of purchase:

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 manufacturers 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 manufacturers 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.

Historical check:

The inspection of this product should be done together with the manufacturers instructions for use.

Visual check of safety components:


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)

TM TR

Check of comfort components:


Condition of the protection elements (strings, stitching protections, protective cover) Condition of the connection-webbing elasticity

TM TR

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

TM TR

Comments:

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

Verdict (tick):

This product may remain in service.


Company:

This product may not remain in service. Date of next inspection:

Date of inspection:
Inspected by: Signature:

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