Fall Pro Equipment Kit Inspection

• Fall Pro Kit Number

• Kit User Name

• Region/Department

• Conducted on

  Date

• Prepared by

• Location
  Address

Kit Inventory

• Harness?

• Trauma Straps on the Harness?

• Twin Nano-Lok SRL?

• 2 Web Chokers?

• 2 Wire Rope Pass-Thru Leash?

• Daily Inspection Log Complete?

• Previous inspection document?

Harness Info:

• Date of Manufacture:

• Serial #

• Model #

• Lot #

• Label Attached to Harness and Fully Legible

  Yes

  No

  N/A

• Does impact indicator show no impact?

  Yes

  No

  N/A

Hardware:

• 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

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• All Buckle Springs Loose?

  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

Self Retracting Lanyard / Lifeline #1 Info:

• SRL Date of Manufacture:

• SRL Serial #

• SRL Model #

• SRL Lot #

• Label Attached and Fully Legible<br>

  Yes

  No

  N/A

SRL Condition:

• Does impact indicator show no impact?

  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 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

Self Retracting Lanyard / Lifeline #2 Info:

• SRL Date of Manufacture:

• SRL Serial #

• SRL Model #

• SRL Lot #

• Label Attached and Fully Legible<br>

  Yes

  No

  N/A

SRL Condition:

• Does impact indicator show no impact?

  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 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

Web Choker Tie-Off Adaptor #1:

• Date of Manufacture:

• Serial #

• Model #

• Lot #

• Label Attached and Fully Legible?<br>

  Yes

  No

  N/A

Hardware Condition:

• Free of 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

Webbing:

• 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

Web Choker Tie-Off Adaptor #2:

• Date of Manufacture:

• Serial #

• Model #

• Lot #

• Label Attached and Fully Legible?<br>

  Yes

  No

  N/A

Hardware Condition:

• Free of 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

Webbing:

• 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

Wire Rope Tie-Off Adaptor #1:

• Date of Manufacture:

• Serial #

• Model #

• Lot #

• Label Attached and Fully Legible?<br>

  Yes

  No

  N/A

Hardware Condition:

• Free of 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

Wire Rope:

• Rope Free of Excessive Grease, Paint, Oil and Dirt?

  Yes

  No

  N/A

• Free of Broken Wires?

  Yes

  No

  N/A

• Free of Bird Caging?

  Yes

  No

  N/A

• Free of Burns/Welding Slag?

  Yes

  No

  N/A

• Free of Kinks?

  Yes

  No

  N/A

• Free of Burns/Welding Slag?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

Wire Rope Tie-Off Adaptor #2:

• Date of Manufacture:

• Serial #

• Model #

• Lot #

• Label Attached and Fully Legible?<br>

  Yes

  No

  N/A

Hardware Condition:

• Free of 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

Wire Rope:

• Rope Free of Excessive Grease, Paint, Oil and Dirt?

  Yes

  No

  N/A

• Free of Broken Wires?

  Yes

  No

  N/A

• Free of Bird Caging?

  Yes

  No

  N/A

• Free of Burns/Welding Slag?

  Yes

  No

  N/A

• Free of Kinks?

  Yes

  No

  N/A

• Free of Burns/Welding Slag?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

Hooks / Carabiners

• Free of corrosion & physical damage?<br>

  Yes

  No

  N/A

• Small carabiners free of corrosion & physical damage?

  0

  1

  2

  3

  4

• Large carabiners free of corrosion & physical damage?

  0

  1

  2

  3

  4

Overall inspection Info:

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

• Signature of Inspector

  Sign