Information

  • Inspection No:

  • Site:

  • Conducted on

  • Prepared by

  • Location: (if applicable/available)

HARNESS Info:

  • Photo of Harness

  • Label Attached to Harness<br>

  • Label Fully Legible

  • HARNESS Date of Manufacture

  • HARNESS Out of Service Date

  • HARNESS Serial #

  • HARNESS Model #

Hardware:

  • Buckles in Place?

  • D Rings in Place?

  • Back Pad in Place?

  • Loop Keepers in Place?

Hardware Condition:

  • Free of Damaged or Worn Parts?

  • Free of Broken or Bent Parts?

  • All Buckle Springs Loose?

  • Free of any Sharp Edges?

  • Free of Burrs?

  • Free of Cracks?

  • Parts free of distortion and elongation?

  • Free Corrosion?

Webbing:

  • Free of Cuts?

  • Webbing free of Frays?

  • Free of Broken Fibers?

  • Free of Broken Stitches?

  • Free of Tears?

  • Free of Abrasions?

  • Free of Mold?

  • Free of Burns?

Overall inspection Info:

  • HARNESS is approved for continuing service

  • Reason for Failure

  • Name / Signature of Inspector

LANYARD Info:

  • Photo of Lanyard

  • LANYARD Date of Manufacture

  • LANYARD Out of Service Date

  • LANYARD Serial #

  • LANYARD Model #

Hardware Condition:

  • Free of Damaged or Worn Parts?

  • Free of Broken or Bent Parts?

  • Free of any Sharp Edges?

  • Free of Burrs?

  • Free of Cracks?

  • Parts free of distortion and elongation?

  • Free Corrosion?

Webbing:

  • Free of Cuts?

  • Webbing free of Frays?

  • Free of Broken Fibers?

  • Free of Broken Stitches?

  • Free of Tears?

  • Free of Abrasions?

  • Free of Mold?

  • Free of Burns?

Overall inspection Info:

  • HARNESS is approved for continuing service

  • Reason for Failure

  • Name / Signature of Inspector

DUAL LANYARD Info:

  • Photo of Lanyard

  • LANYARD Date of Manufacture

  • LANYARD Out of Service Date

  • LANYARD Serial #

  • LANYARD Model #

Hardware Condition:

  • Free of Damaged or Worn Parts?

  • Free of Broken or Bent Parts?

  • Free of any Sharp Edges?

  • Free of Burrs?

  • Free of Cracks?

  • Free Corrosion?

  • Parts free of distortion and elongation?

Webbing:

  • Free of Cuts?

  • Webbing free of Frays?

  • Free of Broken Fibers?

  • Free of Broken Stitches?

  • Free of Tears?

  • Free of Abrasions?

  • Free of Mold?

  • Free of Burns?

Overall inspection Info:

  • HARNESS is approved for continuing service

  • Reason for Failure

  • Name / Signature of Inspector

SELF RETRACTING LANYARD Info:

  • Photo of Lanyard

  • SRL Date of Manufacture

  • SRL Out of Service Date

  • SRL Serial #

  • SRL Model #

SRL Condition:

  • Does impact indicator show no impacted or elongated?

  • Webbing free of frays?

  • Are all screws and fasteners tight and in place?

  • Housing free of any distortion, cracks, and other damage?

  • Lifeline free of cuts, burns, tears, abrasions, frays, excessive soiling, and discoloration?

  • Parts free of distortion and elongation?

  • Does lifeline lock quickly deployed?

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

  • Are hooks & carabiners free of physical damage and corrosion and operate freely?

  • Are all labels present and fully legible?

Overall inspection Info:

  • HARNESS is approved for continuing service

  • Reason for Failure

  • Name / Signature of Inspector

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