Title Page
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Serial No
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Document No.
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Prepared by
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Conducted on
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Client / Site
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Location
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Personnel
Shock absorber lanyard
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Serial number
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Model
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MFG Date
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Type of lanyard
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Brand
Label
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Label
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Serial number
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MFG date older than 5 or 10 years
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Unit Standard
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Company details
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Add media
Stiching
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Stitching safe?
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Stitching coming loose
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Missing
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Apart
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Add media
Webbing
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Is the Webbing safe?
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Cuts
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Abrasions
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Discoloration ( paint, tipex, marker)
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Burns
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Add media
Metals parts
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Is the metal components safe?
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Corrosion (rust)
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Missing
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Bend
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Functionality of the component
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Cracks
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Add media
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Shock absorber
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Deployed
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Missing
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Add media
Safe for use
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Is the product safe for use
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Last 3 months inspection history provided?
Sign off
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Select date
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Add signature
Disclaimer
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Evolution Height Safety does not take any liability or responsibility for any product that is being miss used in any format.
Only use the product is intended and designed for.
Please read the user manual.
Only competent person allowed to use this product.
Personal inspection must be done by the user before and after use!
Results of the equipment is based on the last 3 months inspection information given of the product's history.
