Poweramp • W194 N11481 McCormick Drive • Germantown, WI 53022800.643.5424 • fax: 262.255.4199 • www.poweramp.com

TPR® VEHICLE RESTRAINTSITE SURVEY

Building Wall (Flush)

“TPR”Vehicle Restraint

DockApproach

Dock Face

Pit Depth

Dock Height

Lower Front Curb Angle

INSTRUCTIONS1. Survey must be completed based upon conditions at time of installation.2. Dock face must be clear of any obstructions prior to installation of the TPR®.3. Lights and signs must be mounted in full view of forklift and tractor-trailer operations.4. Examples of why bracketing may be required:

• Sloped approach greater than 1/2” per foot.• Bumper projection over 4”. (Bumpers are manufactured to nominal sizes; actual projection must be

verified).• Insufficient embedded lower front pit curb angle• 24” deep pits.• Other than solid concrete dock face (6” thick minimum).

5. Hollow “D” and flex steel bumpers not acceptable.

TPR Vehicle RestraintUniLock Vehicle Restraint

NOTE: Enter “NONE” for no leveler.

1. Leveler Type:

2. Leveler Brand: Model:3. Lip Length: Inches4. Safety Lip

5. Pit Depth/Front Frame Depth: Inches

Hydraulic Air Mechanical EODVertical Storing Truck Activated None

Yes No

NOTE: Consult Systems Inc. if leveler is on self standing frame.Enter “NONE” if no leveler or “EOD type leveler (refer to EOD drawing on last page.)

Order #:Surveyed By:

Date:Quantity:

# of Pictures*:

Customer:Job:

Address:City:

State & Zip:* Note pictures are useful in seeing what might be missing from this survey. If at all possible please include with this survey

BUILDING AND DOCK PIT DATA

1. Dock/Door #’s:2. Centerline Dimension between Doors: Inches

*Note adequate space is required for mounting signs and lights.

3. Dock Face/TPR Mounting Surface:

4. Is the pit floor material concrete:

5. If pit does not exist, is the dock floor concrete:

6. Is there an existing pit floor plate bracket:

7. Is there an existing wall embed plate:

8. Lower Front Pit Curb Angle

9. Drive/Approach Material at Dock Face

10. Leveler Sub-Frame Position to Dock Face:

11. Leveler Sub-frame Set back or Protrusion: Inches12. Will this application incorporate Trailer Lifts, Wheel Risers, Existing

Brackets (Aftermarket Upgrade) or obstructions on the dock face?

Yes No

Concrete, solid tilt-up precast, min 6” thick Embed mounting plate, minimum 6” thick concreteBrick/cinder block, hollow tilt-up/precast Stub wall (partial wall w/open pit)Legs/Self Stand Frames - (Consult Factory) Other

Yes No

Yes No

3 x 3 4 x 4 None Pan Material Other

Concrete Asphalt Gravel/Dirt Other

Flush Protruding Set Back Not Applicable

No Existing Brackets (Upgrade) Trailer Lift Wheel RisersDock Face Obstructions - Explain:

Yes No

LEVELER DATA

Leveler Lipto Grade

Enter “NONE” for No Cantilever

CantileverDepth

CantileverOverhang

Dock Faceto Drain

DrainDepth

DrainWidth

Bui

ldin

g W

all

Can

tilev

er

Bum

per

Bumper Projection

Dock Height

Approach Level Line

Bui

ldin

g W

all

Driveway Declineat 50ft.

Driveway Inclineat 50ft.

50 FT

Drain and/or Cantilever Conditon (if applicable)

DRIVEWAY DATADriveway Data is required

1. Bumper Projection: Inches2. Wall Position to Dock Face

3. Is the Approach Level or Sloped?

4. Is there a trench located 12” or less from the face of the bumpers?

5. Will Systems Inc. supply cantilever bracket? (if necessary)

6. Will Systems Inc. supply floor bracing? (if necessary)

7. Will Systems Inc. supply additional anchors? (if necessary)

Flush Protruding Set Back

Level Sloped

Yes No

Yes No

Yes No

Yes No

Truck Style A Truck Style B Truck Style C

Truck Height (A)

Truck Bed Height (B)

Extension Length (C)

RIG Height (D)

RIG Size (std=4”x4”)

Make Note if Trucks Vary Considerably.use the 90%/10% rule to capture majority of trailers

Side View of Truck

Truck Extension:(Ledge, Taigate, ect.)

RIG

A

C B

D

Yes No1. Yard Jockey use:2. What types of truck are being service:

Lift Gate FlatbedLTL High Cube VanContainer RefrigeratedTruck has an Obstructed RIG (UniLock Recomended)

ELECTRICAL DATALIGHT DATA

What type of light system is required:Exclusive advance communication 3 light system - Red, Green, Amber (std.)2 light system - Red, Green and Audible Alarm (Not Available with UniLock)

CONTROL BOX OPTIONSCombo Box - Specify product combined with Voltage and PhaseRestraint Engaged InterlockingLeveler Stored Interlocking

TRUCK DATA

EOD DATA

Dock Face

Approach

EOD Back Plate

Operating Mechanism

Bumper

Centerlineof Leveler Centerline

of Mechanism

Note: Enter “NONE” ifmechanism is centered oncenterline of leveler

Bum

per P

roje

ctio

n

Bum

per B

lock

out

Lip

Ope

ratin

g M

echa

nism

Approach

Dock Face

Dock Face

Approach

EOD Back Plate

Operating Mechanism

Bumper

Centerlineof Leveler Centerline

of Mechanism

Note: Enter “NONE” ifmechanism is centered oncenterline of leveler

Bum

per P

roje

ctio

n

Bum

per B

lock

out

Lip

Ope

ratin

g M

echa

nism

Approach

Dock Face

Note: Some hydraulic and/or mechanical devices can effect bracket requirements

Rev. 6-2017