Information
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Company
- Borton
- Greenhill Concrete
- Greenhill Materials
- Greenhill Sand
- Klaver
- Millennial Asphalt
- OCM
- Sherwood Construction
- Wildcat CO
- Wildcat KS
- Wildcat Concrete
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Issued to
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Conducted on
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Prepared by
Harness:
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Manufacturer
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Serial Number
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Manufacture Date
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Photo of harness label and tags
Harness Type:
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Check Type Harnesses Inspecting
- Full-Body Adjustable Harness (Confined Space Retrieval)
- Full-Body Specialty Harness
- Flame Retardant Kevlar/Nomax Welders Harness
- Padded Full-Body Adjustable Harness (Construction Work)
- Flotation Full-Body Adjustable Harness
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Check any items found Bad
- Fraying
- Weld Burns
- Cuts
- Excessive Wear
- Stitching
- Rivets
- Eyelets
- D-Rings
- Buckles
- Body Pad
- Data Tag (Certification data present & legible
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Take photos of any defects found
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Can the Harnesses remain in service?
Lanyards
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Manufacturer
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Serial Number
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Manufacture Date
Lanyard Type:
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Check Type Lanyards Inspecting
- Single
- Double
- Loop On/D-Ring Lanyard
- Hook On
- Adjustable
- Self Retracting Yo-Yo
- Positioning (Chains)
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Check any items found Bad
- Excessive Wear
- Fraying
- Cuts
- Weld Burns
- Deteriorate
- Safety Latch Hook
- D-Rings
- Data Tag (Certification data present & legible)
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Take photos of any defects found
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Can the Lanyards remain in service?
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Comments
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Inspectors Signature:
