FALL PROTECTION INSPECTION CHECKLIST V.2

• Inspection No:

• Site:

• Conducted on

  Date

• Prepared by

• Location: (if applicable/available)
  Address

HARNESS Info:

• Photo of Harness

  Media

• Label Attached to Harness<br>

  Yes

  No

  N/A

• Label Fully Legible

  Yes

  No

  N/A

• HARNESS Date of Manufacture

  Date

• HARNESS Out of Service Date

  Date

• HARNESS Serial #

• HARNESS Model #

Hardware:

• Buckles in Place?

  Yes

  No

  N/A

• D Rings in Place?

  Yes

  No

  N/A

• Back Pad in Place?

  Yes

  No

  N/A

• Loop Keepers in Place?

  Yes

  No

  N/A

Hardware Condition:

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• All Buckle Springs Loose?

  Yes

  No

  N/A

• Free of any Sharp Edges?

  Yes

  No

  N/A

• Free of Burrs?

  Yes

  No

  N/A

• Free of Cracks?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

• Free Corrosion?

  Yes

  No

  N/A

Webbing:

• Free of Cuts?

  Yes

  No

  N/A

• Webbing free of Frays?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Tears?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of Mold?

  Yes

  No

  N/A

• Free of Burns?

  Yes

  No

  N/A

Overall inspection Info:

• HARNESS is approved for continuing service

  Yes

  No

  N/A

• Reason for Failure

• Name / Signature of Inspector

  Sign

LANYARD Info:

• Photo of Lanyard

  Media

• LANYARD Date of Manufacture

  Date

• LANYARD Out of Service Date

  Date

• LANYARD Serial #

• LANYARD Model #

Hardware Condition:

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• Free of any Sharp Edges?

  Yes

  No

  N/A

• Free of Burrs?

  Yes

  No

  N/A

• Free of Cracks?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

• Free Corrosion?

  Yes

  No

  N/A

Webbing:

• Free of Cuts?

  Yes

  No

  N/A

• Webbing free of Frays?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Tears?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of Mold?

  Yes

  No

  N/A

• Free of Burns?

  Yes

  No

  N/A

Overall inspection Info:

• HARNESS is approved for continuing service

  Yes

  No

  N/A

• Reason for Failure

• Name / Signature of Inspector

  Sign

DUAL LANYARD Info:

• Photo of Lanyard

  Media

• LANYARD Date of Manufacture

  Date

• LANYARD Out of Service Date

  Date

• LANYARD Serial #

• LANYARD Model #

Hardware Condition:

• Free of Damaged or Worn Parts?

  Yes

  No

  N/A

• Free of Broken or Bent Parts?

  Yes

  No

  N/A

• Free of any Sharp Edges?

  Yes

  No

  N/A

• Free of Burrs?

  Yes

  No

  N/A

• Free of Cracks?

  Yes

  No

  N/A

• Free Corrosion?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

Webbing:

• Free of Cuts?

  Yes

  No

  N/A

• Webbing free of Frays?

  Yes

  No

  N/A

• Free of Broken Fibers?

  Yes

  No

  N/A

• Free of Broken Stitches?

  Yes

  No

  N/A

• Free of Tears?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of Mold?

  Yes

  No

  N/A

• Free of Burns?

  Yes

  No

  N/A

Overall inspection Info:

• HARNESS is approved for continuing service

  Yes

  No

  N/A

• Reason for Failure

• Name / Signature of Inspector

  Sign

SELF RETRACTING LANYARD Info:

• Photo of Lanyard

  Media

• SRL Date of Manufacture

  Date

• SRL Out of Service Date

  Date

• SRL Serial #

• SRL Model #

SRL Condition:

• Does impact indicator show no impacted or elongated?

  Yes

  No

  N/A

• Webbing free of frays?

  Yes

  No

  N/A

• Are all screws and 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, and discoloration?

  Yes

  No

  N/A

• Parts free of distortion and elongation?

  Yes

  No

  N/A

• Does lifeline lock quickly deployed?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all labels present and fully legible?

  Yes

  No

  N/A

Overall inspection Info:

• HARNESS is approved for continuing service

  Yes

  No

  N/A

• Reason for Failure

• Name / Signature of Inspector

  Sign