Fall Protection Harness Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• General Inspection Rules:
  1.) All PFAS will be inspected by the user BEFORE EACH USE
  2.) The Competent person will inspect PFAS semi-annually (2 times a year) using this form
  3.) When an inspection reveals defects or damage, the equipment shall be removed from service immediately and tagged "Out of Service".

Inspection Checklist Log

• Harness Model:

• Manufacture Date:

  Date

• In Service Date:

  Date

• Purchase Date:

  Date

• Serial Number:

• Issued To:

General Inspection Factors

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

  Pass

  Fail

• Supporting Details:

• Take photo of damage

  Media

• Webbing: Inspect for cuts, frayed edges, burns, chemical deterioration, holes or tears, excessive soiling, and discoloration.

  Pass

  Fail

• Supporting Details:

• Take photo of damage

  Media

• Stitching: Inspect for pulled or cut stitches.

  Pass

  Fail

• Supporting Details:

• Take photo of damage

  Media

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

  Pass

  Fail

• Supporting Details:

• Take photo of illegible tags or labels

  Media

• Overall Disposition:

  Pass

  Fail

• Inspected By:

  Sign