Fall Protection Equipment Inspections

• Fall Protection Equipment Inspecion

• Client / Site

• Conducted on

  Date

• Prepared by:

  Doug Cohrt

  Steve Vander Ecken

  Mustafa Jubeh
• Location
  Address

• Personel

Harness Information

• Image of Harness

  Media

• Size & Model of Harness

  Select XSmall Exofit Vest Small Exofit Vest Medium Exofit Vest Large Exofit Vest XLarge Vest Small Exofit Crossover Medium Exofit Crossover Large Exofit Crossover XL Exofit Crossover 2XL Exofit Universal SM Exofit i safe

  • XSmall Exofit Vest
  • Small Exofit Vest
  • Medium Exofit Vest
  • Large Exofit Vest
  • XLarge Vest
  • Small Exofit Crossover
  • Medium Exofit Crossover
  • Large Exofit Crossover
  • XL Exofit Crossover
  • 2XL Exofit
  • Universal
  • SM Exofit i safe

• Labels Full Legible?

  Yes

  No

  N/A

• Serial #:

• Model #:

• Lot #:

• MFRD:

Hardware:

• Buckles in Place?

  Yes

  No

  N/A

• D Rings in Place?

  Yes

  No

  N/A

• Back Pad in Place?

  Yes

  No

  N/A

Hardware Condition:

• Free of Damaged, Worn, Bent, or Broken Parts?

  Yes

  No

  N/A

• All Buckles Spring Loose?

  Yes

  No

  N/A

• Free of Burrs, Cracks, or Sharp Edges?

  Yes

  No

  N/A

• Free of Distortion & Elongation?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

Webbing Conditions:

• Free of Cuts?

  Yes

  No

  N/A

• Free of Frays, Tears, Abrasions, Mold & Burns?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

Single Lanyard Information:

• Do they have a Single Lanyard?

  Yes

  No

  N/A

• Image of Lanyard

  Media

• Labels Fully Legible?

  Yes

  No

  N/A

• Serial #:

• Model #:

• Lot #:

• MFRD:

Hardware Condition:

• Free of Damaged, Worn, Bent, or Broken Parts?

  Yes

  No

  N/A

• Free of Burns, Cracks, or Sharp Edges?

  Yes

  No

  N/A

• Free of Distortion & Elongation?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

• Impact Indicator Intact?

  Yes

  No

  N/A

Webbing:

• Free of Cuts?

  Yes

  No

  N/A

• Free of Frays, Tears, Abrasions, Mold & Burns?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

Dual Lanyard:

• Do they have a Dual Lanyard?

  Yes

  No

  N/A

• Image of Lanyard

  Media

• Labels Fully Legible?

  Yes

  No

  N/A

• Serial #:

• Model #:

• Lot #:

• MFRD:

Hardware Condition:

• Free of Damaged, Worn, Bent, or Broken Parts?

  Yes

  No

  N/A

• Free of Burns, Cracks, or Sharp Edges?

  Yes

  No

  N/A

• Free of Distortion & Elongation?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

• Impact Indicator Intact?

  Yes

  No

  N/A

Webbing:

• Free of Cuts?

  Yes

  No

  N/A

• Free of Frays, Tears, Abrasions, Mold & Burns?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

Self Retracting Lifeline Info:

• Do they have a SRL?

  Yes

  No

  N/A

• Image of SRL:

  Media

• Labels are Present & Fully Legible?

  Yes

  No

  N/A

• Serial #:

• Model #:

• Lot #:

• MFRD:

SRL Condition:

• Impact Indicator show no signs of impaction or elongation?

  Yes

  No

  N/A

• Webbing / Cables free of Frays?

  Yes

  No

  N/A

• Are all Screws & 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, & discoloration?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

• Does Lifeline lock with no slip after quick deployment?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are Hooks & Carabineers free of physical damage and corrosion and operate freely?

  Yes

  No

  N/A

• Does swivel eye on top move freely if equiped?

  Yes

  No

  N/A

Tie-Off Adaptor:

• Do they have a Tie-Off Adaptor?

  Yes

  No

  N/A

• Image of Tie-Off Adaptor

  Media

• Labels Fully Legible?

  Yes

  No

  N/A

• Serial #:

• Model #:

• Lot #:

• MFRD:

Hardware Condition:

• Free of Damaged, Worn, Bent, or Broken Parts?

  Yes

  No

  N/A

• Free of Burns, Cracks, or Sharp Edges?

  Yes

  No

  N/A

• Free of Distortion & Elongation?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

• Impact Indicator Intact?

  Yes

  No

  N/A

Webbing:

• Free of Cuts?

  Yes

  No

  N/A

• Free of Frays, Tears, Abrasions, Mold & Burns?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

Hooks / Carabineers:

• Do they have any Small Carabineers?

  Yes

  No

  N/A

• Image of Carabineers:

  Media

• Small Carabineers Qty?

  1

  2

  3

  4

• Are Markings Present & Fully Legible?

  Yes

  No

  N/A

• Do they have any Large Carabineers?

  Yes

  No

  N/A

• Image of Carabineers:

  Media

• Large Carabineers Qty?

  1

  2

  3

  4

• Are Markings Present & Fully Legible?

  Yes

  No

  N/A

Ascender Information:

• Do they have an Ascender?

  Yes

  No

  N/A

• Image of Ascender

  Media

• Labels Fully Legible?

  Yes

  No

  N/A

• Serial #:

• Model #:

• Lot #:

• MFRD:

Hardware Condition:

• Free of Damaged & Deformities?

  Yes

  No

  N/A

• Free of Corrosion?

  Yes

  No

  N/A

• Are Locking Levers Free of Damage and Operate Smoothly?

  Yes

  No

  N/A

Overall Inspection Info:

• Does the Equipment meet the Requirements of the Inspection?

  Yes

  No

  N/A

• Images of Failures:

  Media

• Remove & Destroy All Equipment that does not meet Requirements.

• Date of the Inspection:

  Date

• Signature of Inspector:

  Sign