Fall Protection Harness Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Inspection Checklist Log

• Model Number:

• Manufacture Date:

  Date

• Serial Number:

• Lot Number:

• Employee Name:

General Inspection Factors

• Hardware: (Includes D-rings, buckles, keepers, and back pads) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.

  Accepted

  Rejected

• Supporting Details:

• Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, and discoloration.

  Accepted

  Rejected

• Supporting Details:

• Stitching: Inspect for pulled or cut stitches.

  Accepted

  Rejected

• Supporting Details:

• Labels: Inspect, make certain all labels are securely held in place and legible

  Accepted

  Rejected

• Supporting Details:

• Overall Disposition:

  Accepted

  Rejected

• Inspected By:

• Signature:

  Sign

• Date Inspected:

  Date