MSA WORKMAN - Inspection Log

MSA Workman® Tripod
27
US
5.5 Inspection Log
Supplier Address and
Contact Details:
Model No.:
Serial No.:
Date of Manufacture:
Date of Purchase:
Date of First Use:
History of Periodic Examina-
tion (see table):
Date of
Examination
Defects
Found
Corrective
Action/Repair
Responsible
for Repair
Name/
Signature
Date of Next
Examination
Examiners
Name/Signature