J.10 TMT Checklist v3 Hays Mod.xlsx
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Pre Climb Checklist
| Pre-Climb Checklist |
| Before climbing, answer each question below (using binoculars, as applicable). If any of the questions in this section are answered "Yes", do not climb the tower. When climbing, if any of the questions change from "No" to "Yes", either due to inspection or a change in conditions, immediately return to ground. Furthermore, questions may require an interim "Do Not Climb" sign be attached to the tower. For further clarification please refer to Tower Structure Inspection Instruction Guide. |
| 1. Reserved |
| Is the climbing procedure as outlined in FAA Order 3900.19C and ANSI Z359.2 unavailable or not developed by a competent person? |
| 2. Is the rescue plan unavailable or not effective? |
| 3. Do wind speeds exceed 45 mph? |
| 4. Is lightning striking 40 miles away or less? |
| All Towers |
| 5. Are there any power lines within three feet or any transmission lines (>5000 volts) within one hundred feet of any metal tower components including guy wires? |
| 6. From a distance, does the tower appear to lean more than one foot horizontally for each 40 feet of height? |
| 7. From a distance, does the tower appear bowed, kinked or out of alignment at any point more than one foot horizontally in each 40 feet of height? |
| 8. From the base of each tower leg looking up, does the leg appear to be bowed, kinked or twisted out of that straight line more than one foot for each 40 feet of height at any point along the way from bottom to top? |
| 9. Does the ladder/ladder safety system and its connections have hardware missing, excessive rust or major damage? |
| 10. Does the ladder safety system and ladder have ice or other debis that could cause a loss of proper function, footing, or handholds? |
| 11. Has the leg metal rusted so far into the CSF3 stage such that metal is obviously missing or edges of steel are delaminating (edge appears as thin, separating layers rather than one solid thickness/piece)? |
| 12. Is the leg split/cracked at the corners or the weld to the base plate cracked? |
| 13. If the legs are made from pipes or structural tubing welded to plates so as to be closed off at the bottoms (even if weep holes are open), is a dull thud sound heard rather than more of a ring when struck with a hammer near the base/plate? |
| 14. If the bolts used for the leg splices (or base connections) have rusted to CSF3 stage, are any bolts missing from the splice or nuts from the base plate? |
| 15. If the bolts used for the leg splices (or base connections) have not rusted to CSF3 stage, are half the bolts missing from the splice or nuts from the base plate (if a butt type splice, half from the total or from either side of the joint)? |
| First evaluate the condition of all tower members (diagonal and horizontal). A “YES” to any of the three questions below (Questions 16-18) fails the individual brace member. |
If either of the following conditions apply to any SECTION FACE, the tower is not safe to climb:
• IF the number of all FAILED brace members in that SECTION FACE equal more than half of the TOTAL brace members in that SECTION FACE.
• OR, there are four or more vertically consecutive FAILED brace members in that SECTION FACE. 9
| 16. Has the bracing rusted so far into the CSF3 stage such that metal is obviously missing or edges of steel are delaminating (edge appears as thin, separating layers rather than one solid thickness/piece)? 9 |
| 17. Is the bracing bent or bowed more than three inches in a five foot long piece (six inches if a ten foot long piece, etc.)? 9 |
| 18. Are more than half of all bolts used to attach the brace to the tower leg (or its connection plate at the leg) missing or weld cracked more than halfway thru if welded? 9 |
| Guyed Towers ONLY |
| 19. Have any of the tower’s guy wires, connecting hardware or anchor metal rusted to the Corrosion Severity Factor 3 (CSF3) stage? |
| 20. Do concrete guy anchors have large cracks and/or broken/spalled areas that lead to the embedded metal or is more than two feet of vertical concrete surface exposed above grade due to erosion or ground settling? |
| 21. If the tower is >20 years old, are the guy wires connected to a metal rod smaller than one inch in diameter that's in direct contact with the earth with no concrete visible above ground? |
| 22. Do any of the wires for the tower appear to droop or, sag more than one foot from an imaginary line between the anchor and its connection to the tower? |
| 23. If turnbuckles are present near the anchor, are no threads visible inside the barrel portion for either connecting end (connecting rod end flush with or inside the threaded female socket)? |
| 24. Is sharp kinking or fraying of guy wire strands evident at the bend where connected to the anchor or tower (potential for this is much greater if the guy wire/cable has rolled out of the thimble or no thimble is present)? |
| 25. If only two cable clips/clamps are used to connect any of the guy wires either at the anchor or at the tower connection, are they applied incorrectly (saddle on “dead” end, U-bolt over “live” end) or loose? |
| Self Supported Towers ONLY |
| 26. Has the tower foundation concrete at the support legs been covered/buried such that it cannot be readily exposed to permit a leg base inspection? |
| 27. Are the tower legs at the bases supported by any other method than the legs being embedded directly into concrete or by them being connected to either anchor bolts or other metal items that are embedded in the concrete (ex: tower leg base rests on insulator items of unknown material strength)? |
| 28. Does the tower foundation concrete have large cracks and/or broken/spalled areas that lead to the embedded metal at the leg bases or that expose the embedded reinforcing steel or is more than two feet of vertical concrete surface exposed above grade due to erosion or ground settling? |
Site & Assest Data
| Annual Tower Structure Inspection Checklist - Site and Asset Data | |||
| A.1. Site Information | B. Inspection Information | ||
| SSC | FAC Phone # | Inspector | |
| FAC ID | Fire # | Team Members | |
| FAC Type | Police # | Inspection Date | |
| City | Ambulance # | ||
| State | Rescue # | Skies | |
| Total # Tower Structures | # Self Supporting | # Guyed Structures | Windspeed |
| A.2. Tower Information | Direction of Wind From | ||
| Tower ID # | Serial # | Temperature | |
| Year of Construction | Latitude | Contact # | |
| Manufacturer | Longitude | District POC Reviewer | |
| ***File Naming: SSC_Site Ident_Site Type_Year_TMT-Inspection_Tower_#of# | |||
| C.1. Site Sketch (ID North and Tower Numbers) | |||
| (To number the towers according to FAA protocol, face north and number the towers clockwise from 1 to x.) |
| C.2. Tower Sketch (Tower Height, Ob Lights, and Guy Wires/Anchors, as applicable) | |||||||||||
| (Sketch : Guys numbered from bottom to top of point connected on tower - show distance of anchor to tower & indicate torque arms) | |||||||||||
| D. Tower Information | |||||||||||
| D1. What is the tower type? | Self-supporting | Guyed | Monopole | Other | |||||||
| If other, describe: | |||||||||||
| D2. What is the tower shape? | Cylinder | Square Shaft | Square Pyramid | Square Pyramid Base w/Shaft Top | |||||||
| Triangle Shaft | Triangle Pyramid | Triangle Pyramid Base w/Shaft Top | |||||||||
| D3. What is the tower material? | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Wood | Other | |||||||||
| D4. What is the tower height? | feet | ||||||||||
| D5. Face Width | inches | ||||||||||
| D6. If present, where is the antenna feedline/conduit located on the tower? | Inside | Outside | |||||||||
| D7. Number of Sections / Length(s) / Panels (per section or entire tower) | |||||||||||
| D8. Leg Splice 9 | Yes/No | ||||||||||
| D9. Leg Material / Dimensions (At Base) 9 | Leg A / B / C / D (Circle All that apply) | ||||||||||
| Type | Angle Tube | Thickness | inches | ||||||||
| Width / Diameter | inches | ||||||||||
| Material | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Wood | Other | |||||||||
| Leg A / B / C / D (Circle All that apply) | |||||||||||
| Type | Angle Tube | Thickness | inches | ||||||||
| Width / Diameter | inches | ||||||||||
| Material | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Wood | Other | |||||||||
| D10. Leg Material / Dimensions (At Height or Change of Shape) | Leg A / B / C / D (Circle All that apply) | ||||||||||
| Type | Angle Tube | Thickness | inches | ||||||||
| Width / Diameter | inches | ||||||||||
| Material | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Wood | Other | |||||||||
| Leg A / B / C / D (Circle All that apply) | |||||||||||
| Type | Angle Tube | Thickness | inches | ||||||||
| Width / Diameter | inches | ||||||||||
| Material | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Wood | Other | |||||||||
| Confirm Data Initial: | |||||||||||
| E. Obstruction Light Information | |||||||||||
| F1. Ob Light Info | Type | QTY | Material | QTY | Color | QTY | |||||
| Steady-Burning | Incandescent | Red | |||||||||
| Flashing | LED | White | |||||||||
| Red/White | |||||||||||
| Configuration | QTY | Access Method | QTY | Conduit Location | QTY | ||||||
| Single | Platform | Inside | |||||||||
| Dual | Ladder | Outside | |||||||||
| Off Ladder | |||||||||||
| Confirm Data Initial: | |||||||||||
| G. Ladder Information | |||||||||||
| G1. What is the rung shape? | Solid Round | Tubular Round | Angle | ||||||||
| Structural Lumber | Bar | ||||||||||
| G2. What is the side rail shape? | Solid Round | Tubular Round | Angle | ||||||||
| Structural Lumber | Bar | ||||||||||
| G3. What is the ladder material? | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Wood | Aluminum | |||||||||
| Stainless | Fiberglass | ||||||||||
| Other | |||||||||||
| G4. Where is the ladder located? | Inside Tower | Outside Tower | |||||||||
| G5. What is the total ladder height (from ground/floor/roof to top)? | feet | inches | |||||||||
| G6. Are the rungs at least 16" wide? Measure from inside of one side rail to the other. | Yes | No | What is spacing? | inches | |||||||
| G7. Is the rung spacing not more than 12" and uniform throughout? Measure from rung top to rung top. Pay attention to spacing between ladder sections. | Yes | No | What is spacing? | inches | |||||||
| G8. What is the rung diameter? | inches | ||||||||||
| G9. What is the height from the ground/floor/roof to the lowest rung? | feet | inches | |||||||||
| G10. Is the clearance on the climbing side at least 30"? | Yes | No | List any obstructions: | ||||||||
| G11. Is there a 7" backside clearance throughout the ladder length? | Yes | No | If no, describe: | ||||||||
| G12. Is the ladder pitch between 75 & 90 degrees from horizontal? (estimate) | Yes | No | If no, describe: | ||||||||
| G13. Does the ladder extend at least 42" above platform? | Yes | No | If no, what is height? | inches | |||||||
| G14. Is a ladder cage present? | Yes | No | If No, skip to section G. | ||||||||
| G15. What is the ladder cage material? | Coated Steel - Galvanized | Coated Steel - Painted | |||||||||
| Uncoated Steel | Other | ||||||||||
| Confirm Data Initial: | |||||||||||
| H. Ladder Safety System (LSS) Information | |||||||||||
| H1. Is there a LSS present? | Yes | No | If No, skip to section H. | ||||||||
| H2. What type of LSS rail is present? | T Rail (Radian, Antenna Products, etc.) | Tubular Round (Antenna Products, North, etc.) | |||||||||
| Channel Notched (MSA/Rose, etc.) | Solid Round | ||||||||||
| Cable - Galvanized Steel (LadSafe, Latchways, Other) | Cable - Stainless Steel (LadSafe, Latchways, Other) | ||||||||||
| Flat | Other | ||||||||||
| H3. Where is the safety sleeve stored? | At the site | With the ATSS | Other (specify): | ||||||||
| H4. Is the height from the ground/floor/roof to the bottom of the LSS, 42" or less? | Yes | No | If no, what is height? | inches | |||||||
| H5. Who is the manufacturer and what is the model, if identifiable? |
Manufacturer markings are sometimes found on the back of the safety rail and usually found on the safety sleeve. Enter "unknown" if not identifiable.
| H6. Does the LSS extend at least 42" above platform? | Yes | No | If no, what is height? | inches | |||||||
| H7. If the LSS is a rigid rail, does the rail have a top stop (to prevent sleeve from sliding off)? | Yes | No | N/A | ||||||||
| H8. Is a pivot davit mounted at the top of the LSS? | Yes | No | N/A | ||||||||
| H9. If the LSS is a cable, is its diameter at least 3/8"? | Yes | No | N/A | If no, what is diameter? | inches | ||||||
| H10. If the LSS is a cable, are cable guides used every 25'? | Yes | No | N/A | If no, describe: | |||||||
| Confirm Data Initial: | |||||||||||
| I. Platform Information | |||||||||||
| I1. What is the platform type? | Work | Landing | Bridge | Catwalk | |||||||
| I2. What is the platform shape? | Rectangle | Triangle | Square | ||||||||
| I3. What is the platform floor material? | Steel Grating | Solid Metal | Wood | ||||||||
| Coated Steel - Galvanized | Structural Lumber | Other | |||||||||
| I4. Are there unused ports/openings greater then 2"? | Yes | No | |||||||||
| I5. How is the platform accessed and protected? | Swing Gate | 1-Door Hatch | 2-Door Hatch | Offset Opening | |||||||
| Self-Closing Swing Gate | 1-Door Hatch with Counterweight | No Access | |||||||||
| I6. What is the angle at which the hatch cover rests when open? | |||||||||||
| Measure from horizontal (estimate). If 2-door hatch, provide greater angle. | degrees | N/A | |||||||||
| I7. Is the step-across distance from the ladder to the platform between 2.5" and 12"? Or on ladders greater then 16" wide is the distance from the platform to the center of the ladder less then 20"? | Yes | No | If no, what is distance? | inches | |||||||
| I8. Is there a ladder rung located at the platform level? | Yes | No | N/A | ||||||||
| I9. Do vertical grab bars, if present, have the at least same spacing as the ladder side rails but no greater 30"and are at least the equivalent of the round-rung diameters? | Yes | No | N/A | ||||||||
| I10. Is the platform hatch cover constructed of material that has the same strength as the platform? | Yes | No | N/A | ||||||||
| If no, describe: | |||||||||||
| I11. Is the platform hatch cover set flush with the platform, or projects no more than 1"? | Yes | No | N/A | ||||||||
| If no, describe: | |||||||||||
| I12. Conduit, Junction Boxes and Fasteners at Platform Level Secure? | Yes | No | |||||||||
| I13. Is an OSHA-compliant guardrail provided for platforms 4' or more above grade? |
Guardrail height measurements:
Toeboard: 4" (no more than 1/4" gap between platform floor and base of toeboard) Midrail: located between toeboard and top rail so that no opening is greater than 19" Top rail: 42" Guardrail material:
Angle iron: 2x2x3/8"; space between posts 8' or less Standard pipe: 1.5" diameter; space between posts 8' or less
| Wood: 2x4"; space between posts 6' or less | Yes | No | ||||||||
| If no, describe (include measurements): | ||||||||||
| Confirm Data Initial: | ||||||||||
| J. Stairway Information | ||||||||||
| J1. What is the stairway material? | Coated Steel - Galvanized | Structural Lumber | Other | |||||||
| J2. Where is the stairway located? | Inside Tower | Outside Tower | ||||||||
| J3. Are there 4 or more risers (steps) in the stairway? | Yes | No | ||||||||
| J4. Is the stairway at least 22" wide? | ||||||||||
| Measure at narrowest point. | Yes | No | If no, what is the width? | inches | ||||||
| J5. Is tread depth at least 8" for stairs with closed risers or 6" for stairs with open risers? Measure narrowest tread if depth varies. | Yes | No | If no, describe: | |||||||
| J6. Is the approximate stairway rise between 30 and 50 degrees? Estimate. | Yes | No | If no, describe: | |||||||
| J7. Are stair treads slip-resistant? | Yes | No | If no, describe: | |||||||
| J8. If stairway landings/platforms are present, are they at least the width of the stairway and at least 30" in length (measured in the direction of travel)? | Yes | No | N/A | |||||||
| If no, describe: | ||||||||||
| J9. Is a vertical clearance of at least 7' maintained throughout the stairway? | Yes | No | If no, describe: | |||||||
| J10. Is the stairway enclosed on the sides? | No | One side | Both sides | |||||||
| J11. Is there a handrail present? | Yes | No | If no, continue to Pre-Climb Checklist | |||||||
| I12. Is it an OSHA-compliant stair handrail? |
Handrail height measurements:
30-34" from upper surface of handrail to surface of tread in line with face of riser at forward edge of tread Handrail material:
Hardwood: at least 2" diameter Metal pipe: at least 1-1/2" diameter Bracket measurements:
Provide minimum 3" clearance between handrail and wall or any projection from wall
| Spacing between brackets shall not exceed 8' | Yes | No | |
| If no, describe (include measurements): |
Confirm Data Initial:
N/A
N/A N/A N/A
Annual If Guyed
| Annual Tower Structure Inspection Checklist - Guyed Towers | |||||||||||
| B. Inspection Information | |||||||||||
| Inspector | |||||||||||
| Team Members | |||||||||||
| Inspection Date | |||||||||||
| Skies | |||||||||||
| Windspeed | |||||||||||
| Direction of Wind From | |||||||||||
| Temperature | |||||||||||
| Contact # | |||||||||||
| District POC Reviewer | |||||||||||
| E. Guy Cable Information | |||||||||||
| E1. Leg A Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Guy Cable Size (in) | |||||||||||
| Guy Cable Type | |||||||||||
| Initial Tension | |||||||||||
| Height on Tower (ft) | |||||||||||
| Anchor Distance to Tower (ft) | |||||||||||
| Anchor Elevation Relative to Tower Base (ft) | |||||||||||
| E2. Leg B Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Guy Size | |||||||||||
| Guy Type | |||||||||||
| Initial Tension | |||||||||||
| Height on Tower | |||||||||||
| Anchor Distance to Tower (ft) | |||||||||||
| Anchor Elevation Relative to Tower Base (ft) | |||||||||||
| E3. Leg C Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Guy Size | |||||||||||
| Guy Type | |||||||||||
| Initial Tension | |||||||||||
| Height on Tower | |||||||||||
| Anchor Distance to Tower (ft) | |||||||||||
| Anchor Elevation Relative to Tower Base (ft) | |||||||||||
| E4. Leg D Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Guy Size | |||||||||||
| Guy Type | |||||||||||
| Initial Tension | |||||||||||
| Height on Tower | |||||||||||
| Anchor Distance to Tower (ft) | |||||||||||
| Anchor Elevation Relative to Tower Base (ft) | |||||||||||
| Confirm Data Initial: | |||||||||||
| L. Guy Cable Information | |||||||||||
| Problem | Example | ||||||||||
| L1. Anchor Ground | Yes | No | Erosion, Settling, Anchor Head Burried, Drainage, Obstructions | ||||||||
| L2. Anchor Concrete | Yes | No | Cracking, Spalling, Chipped/Broken, DustingErosion, Settling, Anchor Head Burried, Drainage Obstructions | ||||||||
| L3. Anchor Rods/Plates | Yes | No | Broken, Bent, Rust/Corrosion, Cracked Welds | ||||||||
| L4. Are there any problems with the Guy System Hardware? (loose, missing, rust/corrosion, improper installation) | Yes | No | |||||||||
| If yes, explain: | |||||||||||
| L5. Are any of the guy cables damaged or severely rusted/corroded? | Yes | No | |||||||||
| If yes, explain: | |||||||||||
| L6. Are any of the guy cables sagging excessively? | Yes | No | |||||||||
| If yes, explain: | |||||||||||
| L7. Are there any obstructions/transmission lines around the guy cables or anchors? | Yes | No | |||||||||
| If yes, explain: | |||||||||||
| Note: Add Guy Numbering Scheme to Column Headers as Appropriate. | |||||||||||
| Note: Record Ground Resistance for Guy Anchors in Question M6. | |||||||||||
| L8. Leg A Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Measured Tension/Temp | |||||||||||
| L9. Leg B Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Measured Tension/Temp | |||||||||||
| L10. Leg C Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Measured Tension/Temp | |||||||||||
| L11. Leg D Guy Number | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | ____ | |
| Measured Tension/Temp | |||||||||||
| NOTES (Guy Wire System) |
| M. Grounding | ||||
| Problem | ||||
| M1. Tower base grounding | Yes | No | ||
| M2. Tower legs grounding | Yes | No | ||
| M3. Guy wire grounding (bridged and connected to earth ground) | Yes | No | ||
| M4. Down conductors bend radius (must be > 8") | Yes | No | ||
| M5. Grounding/lightning arrest equipment (in place, secure, and corrosion-free) | Yes | No | ||
| N. Obstruction Light Information | ||||
| Problem? | ||||
| N1. OB Light Control Box | Yes | No | ||
| N2. OB Light Photo Cell | Yes | No | ||
| N3. Conduit/Junction Box (Secure) | Yes | No | ||
| N4. Fastener/Hardware (Secure) | Yes | No | ||
| N5. OB Light Bulbs and Lenses -Condition | Yes | No | ||
| Notes: |
| O. Ladder Information | ||||||||||
| O1. Is there a ladder present? | Yes | No | If No continue to Section P | |||||||
| O2. Is the ladder sound? | Yes | No | If no, describe: | |||||||
| O3. Is the ladder free of splinters, sharp edges, burrs, or projections? | Yes | No | If no, describe: | |||||||
| P. Ladder Safety System (LSS) Information | ||||||||||
| P1. Does the LSS function properly? | Yes | No | ||||||||
| P2. Faulty Safety Sleeve/Slider | Yes | No | If yes, describe: | |||||||
| P3. Broken/Bent/Misaligned Sections | Yes | No | If yes, describe: | |||||||
| P4. Rust/Corrosion | Yes | No | If yes, describe: | |||||||
| P5. Loose/Missing Hardware | Yes | No | If yes, describe: | |||||||
| P6. Other | Yes | No | If yes, describe: | |||||||
| Q. Platform Information | ||||||||||
| Q1. Is there a platform present that is more than 4' above the ground/floor/roof? (Measure to floor of platform.) | Yes | No | If No continue to Section R | |||||||
| Q2. Is the platform floor sound (grating adequately secured, no openings into which materials or people may fall, wood in good condition, etc.)? | Yes | No | ||||||||
| If no, describe: | ||||||||||
| Q3. Is the guardrail sound? (Is it capable of withstanding a load of at least 200 pounds applied in any direction? Is hardware rusted or missing? Are rails bent or broken?) | Yes | No | ||||||||
| If no, describe: | ||||||||||
| Q4. Is the platform hatch or swing gate sound? Look for severe corrosion, missing or poorly functioning hinges, etc. 9 | Yes | No | If no, describe: | |||||||
| R. Stairway Information | ||||||||||
| R1. Is a stairway present? | Yes | No | If No Continue to Section S | |||||||
| R2. Is the stairway sound? | Yes | No | If no, describe: | |||||||
| R3. Is the stair handrail sound? | Yes | No | If no, describe: | |||||||
| S. Photo List | ||||||||||
| Naming Method: | SSC_Site Ident_Site Type_Year_Description | ie: CAK_MFD_RTR_2014_Tower-Leg-A-Hardware_1of2 | ||||||||
| * Take several general photos of tower(s) and grounds. Take specific pictures of any noted issues |
N/A N/A N/A N/A N/A N/A
Annual If Self Supporting
| Annual Tower Structure Inspection Checklist - Guyed Towers | ||||||||||
| B. Inspection Information | ||||||||||
| Inspector | ||||||||||
| Team Members | ||||||||||
| Inspection Date | ||||||||||
| Skies | ||||||||||
| Windspeed | ||||||||||
| Direction of Wind From | ||||||||||
| Temperature | ||||||||||
| Contact # | ||||||||||
| District POC Reviewer | ||||||||||
| K. Tower Information | ||||||||||
| K1. Based on the condition of the tower, do you consider this tower safe to climb? | Yes | No | ||||||||
| If problems are found below please explain further in the Notes section, reference line item. | ||||||||||
| Problems | Example | |||||||||
| K2. Ground Around Tower Base Area | Yes | No | Hardware (nuts, bolts, washers) | |||||||
| K3. Foundation Earth | Yes | No | Erosion, Settling, Tilting, Drainage | |||||||
| K4. Foundation Concrete | Yes | No | Dusting, Spalling, Cracking, Honeycombing | |||||||
| K5. Foundation Grout | Yes | No | Cracking, Chipping, Other concerns | |||||||
| K6. Foundation Low Spots | Yes | No | Moisure Collection | |||||||
| K7. Tower Base/Leg Drainage Holes Open | Yes | No | ||||||||
| K8. Bends and Twists | Yes | No | Vertical bends, curves, twists, alignment/lean | |||||||
| K9. Structure Leg | Yes | No | Broken, Bent, Cracked Welds, Rust/Corrosion, Paint/Coating | |||||||
| K10. Structure Hardware (Leg) | Yes | No | Loose, Missing, Cracked, Rust/Corrosion | |||||||
| K11. Brace | Yes | No | Broken, Bent, Cracked Welds, Rust/Corrosion, Paint/Coating | |||||||
| K12. Brace Hardware | Yes | No | Loose, Missing, Cracked, Rust/Corrosion | |||||||
| K13. Antenna Mounting Pipes | Yes | No | Loose, Missing, Cracked, Rust/Corrosion | |||||||
| K14. Antenna Conduit, Junction Boxes and Fasteners Secure? | Yes | No | Loose, Missing, Cracked, Rust/Corrosion | |||||||
| K15. Alignment (enter observed displacements to right of crosshair as positive, left as negative) 9 | ||||||||||
| Selected Elevation (ft) | Width of Face at That Elevation | Displacement at that Elevation on leg ___ | Displacement at that Elevation on leg ___ | Displacement at that Elevation on leg ___ | Displacement at that Elevation on leg ___ | Total Calc Disp (in) |
NOTES
| M. Grounding | ||||
| Problem | ||||
| M1. Tower base grounding | Yes | No | ||
| M2. Tower legs grounding | Yes | No | ||
| M3. Guy wire grounding (bridged and connected to earth ground) | Yes | No | ||
| M4. Down conductors bend radius (must be > 8") | Yes | No | ||
| M5. Grounding/lightning arrest equipment (in place, secure, and corrosion-free) | Yes | No | ||
| N. Obstruction Light Information | ||||
| Problem? | ||||
| N1. OB Light Control Box | Yes | No | ||
| N2. OB Light Photo Cell | Yes | No | ||
| N3. Conduit/Junction Box (Secure) | Yes | No | ||
| N4. Fastener/Hardware (Secure) | Yes | No | ||
| N5. OB Light Bulbs and Lenses -Condition | Yes | No | ||
| Notes: |
| O. Ladder Information | ||||||||||
| O1. Is there a ladder present? | Yes | No | If No continue to Section P | |||||||
| O2. Is the ladder sound? | Yes | No | If no, describe: | |||||||
| O3. Is the ladder free of splinters, sharp edges, burrs, or projections? | Yes | No | If no, describe: | |||||||
| P. Ladder Safety System (LSS) Information | ||||||||||
| P1. Does the LSS function properly? | Yes | No | ||||||||
| P2. Faulty Safety Sleeve/Slider | Yes | No | If yes, describe: | |||||||
| P3. Broken/Bent/Misaligned Sections | Yes | No | If yes, describe: | |||||||
| P4. Rust/Corrosion | Yes | No | If yes, describe: | |||||||
| P5. Loose/Missing Hardware | Yes | No | If yes, describe: | |||||||
| P6. Other | Yes | No | If yes, describe: | |||||||
| Q. Platform Information | ||||||||||
| Q1. Is there a platform present that is more than 4' above the ground/floor/roof? (Measure to floor of platform.) | Yes | No | If No continue to Section R | |||||||
| Q2. Is the platform floor sound (grating adequately secured, no openings into which materials or people may fall, wood in good condition, etc.)? | Yes | No | ||||||||
| If no, describe: | ||||||||||
| Q3. Is the guardrail sound? (Is it capable of withstanding a load of at least 200 pounds applied in any direction? Is hardware rusted or missing? Are rails bent or broken?) | Yes | No | ||||||||
| If no, describe: | ||||||||||
| Q4. Is the platform hatch or swing gate sound? Look for severe corrosion, missing or poorly functioning hinges, etc. 9 | Yes | No | If no, describe: | |||||||
| R. Stairway Information | ||||||||||
| R1. Is a stairway present? | Yes | No | If No Continue to Section S | |||||||
| R2. Is the stairway sound? | Yes | No | If no, describe: | |||||||
| R3. Is the stair handrail sound? | Yes | No | If no, describe: | |||||||
| S. Photo List | ||||||||||
| Naming Method: | SSC_Site Ident_Site Type_Year_Description | ie: CAK_MFD_RTR_2014_Tower-Leg-A-Hardware_1of2 | ||||||||
| * Take several general photos of tower(s) and grounds. Take specific pictures of any noted issues |
N/A N/A N/A N/A N/A
Findings Summary
| Annual Tower Structure Inspection Checklist - Findings Summary | |||||||
| A.1. Site Information | B. Inspection Information | ||||||
| SSC | FAC Phone # | Out Brief Date | |||||
| FAC ID | Fire # | Inspection Date | |||||
| FAC Type | Police # | Inspector | |||||
| City | Ambulance # | Team Members | |||||
| State | Rescue # | ||||||
| Total # Tower Structures | # Self Supporting | # Guyed Structures | |||||
| A.2. Tower Information | SSC Manager | ||||||
| Tower ID # | Serial # | Manager Contact # | |||||
| Year of Construction | Latitude | District POC Reviewer | |||||
| Manufacturer | Longitude | District POC Contact # | |||||
| Question # | Finding Description | Recommended Repair | Action Description (NAP, 2nd Level Review, SSC Repair) | Responsibility |
Notes:
File details come from the government source that posted it. Updated .