Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
Select date
-
Add location
-
Person(s) Conducting:
Full Body Harness Checklist/Log
-
Full Body Harness Model: Manufacture/Lot Date: Serial Number: Purchase Date:
-
Hardware:<br>(Includes D-rings, buckles, keepers, & back pads)<br>Inspect for damage, distortion, sharp edges, burrs, cracks, & corrosion
-
Webbing:<br>Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, & discoloration
-
Stitching:<br>Inspect for pulled or cut stitches
-
Labels:<br>Make certain all labels are securely held in place & legible
-
Other:<br>Please describe below
Lanyards Inspection Checklist/Log
-
Lanyard Model: Manufacture/Lot Date: Serial Number: Purchase Date:
-
Hardware:<br>(Includes D-rings, buckles, keepers, & back pads)<br>Inspect for damage, distortion, sharp edges, burrs, cracks, & corrosion
-
Webbing:<br>Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, & discoloration
-
Stitching:<br>Inspect for pulled or cut stitches
-
Synthetic Rope:<br>Inspect for pulled or cut yarns, burns, abrasion, knots, excessive soiling & discoloration
-
Wire Rope:<br>Inspect for broken wires, corrosion, kinks, & separation of strands
-
Energy Absorbing Component:<br>Inspect for elongation, tears, & excessive soiling
-
Labels:<br>Make certain all labels are securely held in place & legible
-
Other:<br>Please describe below
Hooks/Carabiners Inspection Checklist/Log
-
Hook/Carabiner Model: Manufacture/Lot Date: Serial Number: Purchase Date:
-
Hardware:<br>(Includes D-rings, buckles, keepers, & back pads)<br>Inspect for damage, distortion, sharp edges, burrs, cracks, & corrosion
-
Webbing:<br>Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, & discoloration
-
Stitching:<br>Inspect for pulled or cut stitches
-
Labels:<br>Make certain all labels are securely held in place & legible
-
Other:<br>Please describe below
Tie-Off Adaptors/Anchorage Plates Inspection Checklist/Log
-
Tie-Off Adaptor/Anchorage Plate Model: Manufacture/Lot Date: Serial Number: Purchase Date:
-
Physical Damage:<br>Inspect for cracks, sharp edges, burns, deformities, & locking operation
-
Excessive Corrosion:<br>Inspect for corrosion which effects the operation &/or strength
-
Fasteners:<br>Inspect for corrosion, tightness damage & distortion. If welded, inspect weld for corrosion, cracks & damage
-
Markings:<br>Make certain marking(s) are legible
-
Other:<br>Please describe below
Self Retracting Lifelines Inspection Checklist/Log
-
Self Retracting Lifeline Model: Manufacture/Lot Date: Serial Number: Purchase Date:
-
Impact Indicator:<br>Inspect indicator for activation (rupture of red stitching, elongated, etc.)
-
Screws/Fasteners:<br>Inspect for damage & make certain all screws & fasteners are tight
-
Housing:<br>Inspect for distortion, cracks & other damage. Inspect anchoring loop for distortion & damage
-
Lifeline:<br>Inspect for cuts, burns, tears, abrasion, frays, excessive soiling & discoloration, broken wires
-
Locking Action:<br>Inspect for proper lock-up of brake mechanism
-
Retraction/Extension:<br>Inspect spring tension by pulling lifeline out fully and allowing it to retract fully (no slack)
-
Hooks/Carabiners:<br>Inspect for physical damage, corrosion, proper operation markings (see separate checklist/log for hooks & carabiners)
-
Reserve Lifeline: <br>Inspect reserve lifeline retention systems for deployment
-
Labels:<br>Make certain all labels are securely held in place & legible
-
If all that applies has been completed please sign:
