Information

  • Site conducted

  • Employee/Owner Name:

  • Date/Time:

BUCKINGHAM BODY BELT AND POLE STRAP INSPECTION

Body Belt

  • Webbing, Nylon, & Leather

  • Hardware

  • Accessory Attachments, Tool Loops, & Pouch Tabs

Fall Restraint

  • Webbing, Nylon, & Leather

  • Hardware

  • Secondary

BUCKINGHAM FULL BODY HARDNESS & SHOCK ABSORBING LANYARD INSPECTION

Full Body Harness

  • Webbing

  • Hardware

  • Attachment Points

Shock Absorbing Lanyard

  • Webbing

  • Hardware

BUCKINGHAM CLIMBER INSPECTION

  • Climber Pads

  • Climber Leg Irons

  • Foot Straps/Leg Straps

  • Hardware

  • Gaffs

RUBBER GLOVES AND SLEEVES INSPECTION

Rubber Gloves

  • Date Tested

  • Condition

  • Protectors

  • Storage Bag

Rubber Sleeves

  • Date Tested

  • Condition

  • Storage Bag

SAFETY GLASSES, HARD HAT, HEARING PROTECTION, & POUCH INSPECTION

Safety Glasses (Z87.1)

  • Condition

Hard Hat

  • Physical Condition

  • Hard Hat Liner Condition

Hearing Protection

  • General Condition

  • Cleanliness

Pouch

  • General Condition

TOOL BAG AND TOOL INSPECTION

Tool Bag

  • Condition

Tools

Hammer

  • Condition

12" Crescent Wrench

  • Condition

8" Crescent Wrench

  • Condition

Speed Wrench

  • Condition

Pliers

  • Condition

Screwdriver

  • Condition

Skinning Knife

  • Condition

Ruler

  • Condition

Other Tools

  • Condition

AUDITOR VERIFICATION SIGNATURE

  • Comments:

  • Signature:

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