Fall Arrest Inspection

• Tag/Bag Number:

• Harness User Name

• Conducted on

  Date

• Prepared by

Harness Info:

• HARNESS Date of Manufacture:

• PREVIOUS inspection Date:

• HARNESS Brand and Model #

• HARNESS Serial #

• HARNESS Lot #

Hardware:

• Label Attached to Harness and Fully Legible

  Yes

  No

  N/A

• Impact Indicators Intact?

  Yes

  No

  N/A

• Buckles in Place?

  Yes

  No

  N/A

• D Rings in Place?

  Yes

  No

  N/A

• Back Pad in Place?

  Yes

  No

  N/A

• Loop Keepers in Place?

  Yes

  No

  N/A

Hardware Condition:

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• Free of any Sharp Edges?

  Yes

  No

  N/A

• Free of Burrs?

  Yes

  No

  N/A

• Free of Cracks?

  Yes

  No

  N/A

• Free Corrosion?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

Webbing:

• Free of Grease, Paint, Oil and excessive Dirt?

  Yes

  No

  N/A

• Free of Cuts?

  Yes

  No

  N/A

• Webbing free of Frays?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Tears?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of Mold?

  Yes

  No

  N/A

• Free of Burns?

  Yes

  No

  N/A

Lanyard Info:

• LANYARD Date of Manufacture:

• PREVIOUS inspection Date:

• LANYARD Serial #

• LANYARD Brand and Model #

• LANYARD Lot #

Hardware Condition:

• Label Attached and Fully Legible<br>

  Yes

  No

  N/A

• Is the impact indicator intact?

  Yes

  No

  N/A

• Gate Meets CSA 3600lb requirements

  Yes

  No

  N/A

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• Free of any Sharp Edges?

  Yes

  No

  N/A

• Free of Burrs?

  Yes

  No

  N/A

• Free of Cracks?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

• Free Corrosion?

  Yes

  No

  N/A

Webbing:

• Free of Grease, Paint, Oil and excessive Dirt?

  Yes

  No

  N/A

• Free of Cuts?

  Yes

  No

  N/A

• Webbing free of Frays?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of Mold?

  Yes

  No

  N/A

• Free of Burns?

  Yes

  No

  N/A

Dual Lanyard Info:

• LANYARD Date of Manufacture:

• PREVIOUS inspection Date:

• LANYARD Serial #

• LANYARD Brand and Model #

• LANYARD Lot #

Hardware Condition:

• Label Attached and Fully Legible<br>

  Yes

  No

  N/A

• Is the impact indicator intact?

  Yes

  No

  N/A

• Gate Meets CSA 3600lb requirements

  Yes

  No

  N/A

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• Free of any Sharp Edges?

  Yes

  No

  N/A

• Free of Burrs?

  Yes

  No

  N/A

• Free of Cracks?

  Yes

  No

  N/A

• Free Corrosion?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

Webbing:

• Free of Grease, Paint, Oil and excessive Dirt?

  Yes

  No

  N/A

• Free of Cuts?

  Yes

  No

  N/A

• Webbing free of Frays?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of Mold?

  Yes

  No

  N/A

• Free of Burns?

  Yes

  No

  N/A

Self Retracting Lanyard / Lifeline Info:

• SRL Date of Manufacture:

• PREVIOUS inspection Date:

• SRL Serial #

• SRL Brand and Model #

• SRL Lot #

SRL Condition:

• Label Attached and Fully Legible<br>

  Yes

  No

  N/A

• Is the impact indicator intact?

  Yes

  No

  N/A

• Webbing Free of Grease, Paint, Oil and excessive Dirt?

  Yes

  No

  N/A

• Webbing free of frays?

  Yes

  No

  N/A

• Are all screws and fasteners tight and in place?

  Yes

  No

  N/A

• Housing free of any distortion, cracks, and other damage?

  Yes

  No

  N/A

• Lifeline free of cuts, burns, tears, abrasions, frays, excessive soiling, and discoloration?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

• Does lifeline lock when quickly deployed?

  Yes

  No

  N/A

• Does lifeline retract fully with no slack after full deployment?

  Yes

  No

  N/A

• Are hooks & carabiners free of physical damage and corrosion and operate freely?

  Yes

  No

  N/A

• Are all labels present and fully legible?

  Yes

  No

  N/A

Overall inspection Info:

• IF INSPECTION REVEALS ANY DEFECTIVE CONDITION, REMOVE FROM SERVICE AND DESTROY.

• Signature of Inspector

  Sign