Information
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Employee/Owner Name:
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Date/Time:
BUCKINGHAM BODY BELT AND POLE STRAP INSPECTION
Body Belt
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Webbing, Nylon, & Leather
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Hardware
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Accessory Attachments, Tool Loops, & Pouch Tabs
Fall Restraint
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Webbing, Nylon, & Leather
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Hardware
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Secondary
BUCKINGHAM FULL BODY HARDNESS & SHOCK ABSORBING LANYARD INSPECTION
Full Body Harness
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Webbing
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Hardware
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Attachment Points
Shock Absorbing Lanyard
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Webbing
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Hardware
BUCKINGHAM CLIMBER INSPECTION
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Climber Pads
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Climber Leg Irons
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Foot Straps/Leg Straps
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Hardware
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Gaffs
RUBBER GLOVES AND SLEEVES INSPECTION
Rubber Gloves
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Date Tested
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Condition
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Protectors
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Storage Bag
Rubber Sleeves
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Date Tested
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Condition
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Storage Bag
SAFETY GLASSES, HARD HAT, HEARING PROTECTION, & POUCH INSPECTION
Safety Glasses (Z87.1)
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Condition
Hard Hat
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Physical Condition
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Hard Hat Liner Condition
Hearing Protection
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General Condition
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Cleanliness
Pouch
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General Condition
TOOL BAG AND TOOL INSPECTION
Tool Bag
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Condition
Tools
Hammer
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Condition
12" Crescent Wrench
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Condition
8" Crescent Wrench
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Condition
Speed Wrench
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Condition
Pliers
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Condition
Screwdriver
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Condition
Skinning Knife
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Condition
Ruler
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Condition
Other Tools
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Condition
AUDITOR VERIFICATION SIGNATURE
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Comments:
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Signature:
