FALL PROTECTION INSPECTION Other than Body Harness

• Site:

• Assigned To:

• Conducted on

  Date

• Inspected by:

• Location: (if applicable/available)
  Address

Fall Equipment Info:

• Photo of Equipment

  Media

• Date of Manufacture

  Date

• Type of Fall protection Equipment

  Select 6' Shock Absorbing Lanyard 3' Shock Absorbing Lanyard SRL (Self Retracting Lanyard) Single Leg PRL (Personal Retracting Lanyard ) Positioning Device Vertical Life Line Horizontal Life Line Anchor Strap Positioning Device Dual leg (PRL) Other

  • 6' Shock Absorbing Lanyard
  • 3' Shock Absorbing Lanyard
  • SRL (Self Retracting Lanyard)
  • Single Leg PRL (Personal Retracting Lanyard )
  • Positioning Device
  • Vertical Life Line
  • Horizontal Life Line
  • Anchor Strap
  • Positioning Device
  • Dual leg (PRL)
  • Other

• Out of Service Date

  Date

• Serial #

• 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

• Load indicator has not been deployed?

  Yes

  No

  N/A

• Are Labels present and readable?

  Yes

  No

  N/A

• Does life line retract and work properly?

  Yes

  No

  N/A

• Are all hooks working and in good condition?

  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

Steel Cable

• Free of broken Strands?

  Yes

  No

  N/A

• Free of soft spots?

  Yes

  No

  N/A

• Free of bird caging?

  Yes

  No

  N/A

• Free of bends ?

  Yes

  No

  N/A

• Free of Abrasions?

  Yes

  No

  N/A

• Free of rust/corrosion?

  Yes

  No

  N/A

Overall inspection Info:

• Fall protection equipment is approved for continuing service

  Yes

  No

  N/A

• Reason for Failure

• Name / Signature of Inspector

  Sign