3M Mobile SkyWalk Series Horizontal Lifeline Product Return Form

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1 3M Mobile SkyWalk Series Horizontal Lifeline Product Return Form THIS FULLY COMPLETED DOCUMENT MUST BE INCLUDED WITH EACH RETURN SHIPMENT IN ORDER FOR CREDIT TO BE ISSUED. ALL CREDITS WILL BE ISSUED TO THE DISTRIBUTOR INDICATED ON RETURN SHIPMENT FORM AT CURRENT PRODUCT COST. ALL RETURN SHIPMENTS MUST BE IDENTIFIED WITH RGA# SWSW914 ON EACH PACKAGE. SHIP ALL SWSW SYSTEMS OR COMPONENT RETURNS VIA UPS GROUND USING 3M UPS SHIPPING ACCOUNT NUMBER: 65W813 Distributor Name: Date of Return Shipment: Distributor 3M Account Number: Distributor Contact Person: Location: Distributor Phone: Distributor Fax Quantity Returned: Please indicate quantities of each component returned on the attached form. Customer Name: Contact Person: Customer Phone #: Quantity Returned: Please indicate quantities of each component returned on the attached form. SHIP THIS FULLY COMPLETED FORM AND AFFECTED PRODUCTS TO: Montage Inc 912 Industrial Drive Milbank, SD RGA# SWSW914 Attn: Barb Bear Each returned package must clearly identify the RGA number on the outside of packaging. Product credit will be issued to the 3M Distributor indicated on this form at current 3M distributor pricing. 1 of 6

2 Products, September 2014 Product Recall List, September 2014 Connectors SWSW Connectors SWSW 06X Connectors SWSW Lifeline System Stud Bracket SWSW 06, 1 ea/case Lifeline System Flat Surface Weld Stud Bracket 1 ea/case Lifeline System PVC Sleeve SWSW 13, 1 ea/case The Stud Bracket has a receiver sleeve for the Aluminum Post Stanchions. The Stub Bracket may be attached to the base of a rebar cage, around the top of a concrete column, or through a concrete wall. The Flat Surface Weld Bracket is a weldable version of the Stud Bracket SWSW 06. It is constructed with 3/4 inch thick, 14 1/2 by 8 inch zinc plated steel, and Schedule 80 pipe as the receiver sleeve for the Aluminum Post Stanchion. The PVC Sleeve is 12 inches tall with a 4 inch inside diameter, and constructed of 4 inch Schedule 40 PVC. PVC Sleeve is cast into concrete and receives the Aluminum Posts Stanchions. Connectors SWSW Lifeline System Flat Base SWSW 29, 1 ea/case The Flat Base, constructed with 5/8 inch Steel and Schedule 40 Pipe, is designed to mount onto flat surfaces and to be used with the Aluminum Post Stanchion. Mounting holes are for 3/4 inch Grade 8 bolts or concrete anchor; mounting hardware is not included. Connectors SWSW 08A Lifeline System Aluminum Post Stanchion SWSW 08A, 1 ea/case The end/intermediate Aluminum Posts Stanchions are 7 1/2 feet long with a 3 1/2 inch outside diameter. Each post has 2 sets of 9/16 inch holes set 4 inches apart and at 90 for the SWSW 01 eyebolts (not included). Connectors SWSW Lifeline System Swivel Cap SWSW 22, 1 ea/case The Swivel Cap is placed over the top of the Aluminum Post Stanchion creating an elevated individual anchor point. A Self Retracting Lanyard may be attached to the Swivel Cap allowing the user to work 360. Connectors SWSW Lifeline System Skyhook Bracket SWSW 24, 1 ea/case The SkyHook Bracket clamps to # 9 or larger stirruped rebar, with two 2 inch inside diameter J bolts, at 6 1/2 feet above the working surface. A safety strap wraps around the rebar cage, creating an anchor point at the proper height for the Mobile Skywalk. The SkyBracket is constructed with aluminum and two 30 inch threaded bars that clamp to #9 or larger stirruped rebar. Installed at 6 1/2 feet above the working surface, it Connectors SWSW 30A Lifeline System Skyhook Bracket SWSW 30A, 1 ea/case creates an anchor point at the proper height for the Mobile Skywalk Horizontal Lifeline. Connectors SWPC SWPC 02, 1 ea/case 10 mm Lifeline Intermediate Support used with SWPC 15 and SWPC 08. Connectors SWPC 08 N/A N/A N/A Runner used with SWPC 15 and SWPC 02. Connectors SWPC 15 N/A N/A N/A Corner Pipe used with SWPC 08 and SWPC 02. Connectors SWSW 24XL Lifeline System Skyhook Bracket SWSW 24XL, 1 ea/case Same as the SWSW 24 except the J bolts are 3.5 inch versus 2 inch. Connectors SWSW Lifeline System Corner Post Bracket, 1 ea/case Corner bracket for SWSW 08A post, angled bracket 12 inches length. Connectors SWSW Connectors SWSW 06BP Lifeline System Sloped Wall Bracket SWSW 31, 1 ea/case Sloped wall bracket for Mobile Skywalk system for SWSW 08A post. SWSW 06, 1 ea/case Back plate for SWSW of 6

3 Products, September 2014 PowerBrake SWSW Assemblies SWMS Lifeline System Power Brake SWSW 18, 1 ea/case 3M 200 ft Galvanized Skywalk SWMS 200, horizontal lifeline. The Power Brake is as the inline energy absorber designed to limit the maximum arrest load to less than 1,650 lb. on the end anchorages. 200 ft Galvanized Steel for Mobile Skywalk horizontal lifeline systems. assembly includes one finished swaged end, and one unfinished end with (2) Fist Grips Assemblies SWMS 30 SS Assemblies SWMS 60 SS Assemblies SWMS 100 SS M 30 ft Stainless Steel Skywalk SWMS 30 SS, 3M 60 ft Stainless Steel Skywalk SWMS 60 SS, 3M 100 ft Stainless Steel Skywalk SWMS 100 SS, 30 ft Stainless Steel for Mobile Skywalk horizontal lifeline systems. assembly includes one finished 60 ft Stainless Steel for Mobile Skywalk horizontal lifeline systems. assembly includes one finished 100 ft Stainless Steel for Mobile Skywalk horizontal lifeline systems. assembly includes one finished Assemblies SWMS 200 SS Accessories SWSW Accessories SWSW Accessories SWSW M 200 ft Stainless Steel Skywalk SWMS 200 SS, Lifeline System Shackle SWSW 03, 1 ea/case 200 ft Stainless Steel for Mobile Skywalk horizontal lifeline systems. assembly includes one finished horizontal lifeline. The Shackle is 1/2 in. and is a cable termination point. The Eye Nut attaches to the Eye Bolt to create an attachment point on the opposite side of the Aluminum Lifeline System Shoulder Eye Nut Posts Stanchion. They are zinc plated and have a one inch SWSW10, 1 ea/case inside diameter eye. Lifeline System Shoulder Nut Eyebolt SWSW 01, 1 ea/case horizontal lifeline. The zinc plated Eye Bolt for the aluminum post stanchions are 5 inches long with a one inch inside diameter eye and comes with a washer and nut. Accessories SWSW DD Lifeline System Dywidag Threadbar SWSW DD, 1 ea/case Replacement part: 30" dywidag threadbar used with the SWSW 06 Not available Accessories SWSW N Lifeline System Dywidag Nut SWSW N, 1 ea/case Replacement part: 5/8" dywidag nut used with the SWSW 06. Tensioners SWSW Tensioners SWSW Lifeline System Come Along SWSW 02, 1 ea/case Lifeline System Adjustable Safety Link SWSW 05, 1 ea/case The Come Along is constructed of zinc plated steel with 12 feet of 7/32 inch Aircraft cable to adjust tension in the Mobile Skywalk lifeline. It must always be used in conjunction with the SWSW 05 Adjustable Safety Link. The Adjustable Safety Link is constructed of 1 inch polyester webbing and is adjustable from 3 to 6 feet. The Adjustable Safety Link must be used with the Come along. A standard carabiner (not included) on each end is used to connect it to the system. 3 of 6

4 Products, September 2014 Tensioners SWPC Lifeline System Pre tensioner Component SWPC 17, 1 ea/case horizontal lifeline. The SWPC 17 Pre Tensioner is designed to easily identify if the Mobile Skywalk Horizontal Lifeline has been properly tensioned. Tensioners SWSW Lifeline System Shackle Block SWSW 20, 1 ea/case Shackle used with Mobile Skywalk to tie back the cable system. Along SWSWKIT SWSWKIT1, 30 ft. Stainless Steel, 1 Kit Stainless Steel, Come Along, Power Brake, Pre in Along SWSWKIT SWSWKIT2, 30 ft. Galvanized, 1 Kit Galvanized, Come Along, Power Brake, Pre in Along SWSWKIT SWSWKIT5, 60 ft. Stainless Steel, 1 Kit Stainless Steel, Come A Long, Power Brake, Pre in Along SWSWKIT SWSWKIT6, 60 ft. Galvanized, 1 Kit Galvanized, Come A Long, Power Brake, Pre in Stainless Steel, Come A Long, Power Brake, Pre SWSWKIT9, Along SWSWKIT ft. Stainless Steel, 1 Kit in Storage Bag Along SWSWKIT SWSWKIT10, 100 ft. Galvanized, 1 Kit Galvanized, Come A Long, Power Brake, Pre in Along SWSWKIT SWSWKIT13, 200 ft. Stainless Steel, 1 Kit Stainless Steel, Come A Long, Power Brake, Pre Tensioner, Link, (4) Carabiners, (2) Fist Grip, and Thimble in Along SWSWKIT SWSWKIT14, 200 ft. Galvanized, 1 Kit Galvanized, Come A Long, Power Brake, Pre in 4 of 6

5 Products, September 2014 Kits Turnbuckle SWSWKIT SWSWKIT3, 30 ft. Stainless Steel, 1 Kit Stainless Steel, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT4, 30 ft. Galvanized, 1 Kit Galvanized, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT7, 60 ft. Stainless Steel, 1 Kit Stainless Steel, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT8, 60 ft. Galvanized, 1 Kit Galvanized, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT11, 100 ft. Stainless Steel, 1 Kit Stainless Steel, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT12, 100 ft. Galvanized, 1 Kit Galvanized, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT15, 200 ft. Stainless Steel, 1 Kit Stainless Steel, Turnbuckle, Power Brake, Pre Kits Turnbuckle SWSWKIT SWSWKIT16, 200 ft. Galvanized, 1 Kit Galvanized, Turnbuckle, Power Brake, Pre 5 of 6

6 Products, September 2014 Kit PVC Sleeve SWSWKIT SWSWKIT17, 1 Kit This horizontal lifeline system kit contains (2) PVC Sleeves and (2) Shoulder Eye Bolts. Accessories SWSW M Variant Length Variant length cable product. Accessories 0216 R Accessories SWSW Accessories SWSW Accessories Accessories SWSW M Lifeline Traveler 0216 R, 1 ea/case Lifeline traveler is for cable or rope lifelines up to 1/2 inch. Lifeline System Turnbuckle SWSW 04, 1 ea/case Lifeline System Fist Grip SWSW 11, 1 ea/case 3M Fall Protection Autolock Carabiner , 1ea/case horizontal lifeline. The Jaw and Jaw 5/8 inch Turnbuckle is constructed of forged galvanized steel and adjusts from 18 to 28 inches. The unfinished end of the Mobile Skywalk is used for system length adjustment. The Fist Grips are used to secure the unfinished end of the Mobile Skywalk once adjustment is complete. Fall protection safety equipment steel autolock carabiner with 0.78" gate opening. Swedge Clamp SWSW12, 5/16in, Lifeline Systems 1/case Swedge clamp. N/A Accessories SWSW 12T Accessories SWMS Accessories SWMS M(TM) Thimble SS SWSW12T, 5/16in, Lifeline Systems 1/case 3M 30 ft Galvanized Skywalk SWMS 30, 3M 60 ft Galvanized Skywalk SWMS 60, Thimble (replacement part) included in cable assembly. 30 ft Galvanized Steel for Mobile Skywalk temporary horizontal lifeline systems. assembly includes on finished swaged end, and one unfinished end with two fist grips and thimble for manual termination. 60 ft Galvanized Steel for Mobile Skywalk temporary horizontal lifeline systems. assembly includes on finished swaged end, and one unfinished end with two fist grips and thimble for manual termination. Accessories SWMS M 100 ft Galvanized Skywalk SWMS 100, 100 ft Galvanized Steel for Mobile Skywalk temporary horizontal lifeline systems. assembly includes on finished swaged end, and one unfinished end with two fist grips and thimble for manual termination. 6 of 6

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