Harness Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• Employee Identification Number (EIN)

Harness/Attachment Information (check all that apply. Indicate and provide specified information below for each piece of fall protection equipment that is being inspected.)

• Employee Name:

• Employee Height:

• Employee Weight:

• Body Harness

• Retractable

• Double Retractable

• Double Lanyard

• Positioning Chain

• Brand

  Select Other Palmer Safety

  • Other
  • Palmer Safety

• Serial Number

Harness Inspection

• Hardware - look for damaged, broken, missing or distorted Hooks, D-rings, Buckles and eyelets. Release tabs on buckles must work freely and click when the buckle engages.

  Safe

  At Risk

  N/A

• Stitching & Webbing - Look for frayed, cut, or broken fibers and stitches. Broken stitches may indicate the harness or device has been subjected to a fall. Other signs of damage: tears, abrasions, mold, burns, or discolorations from ultraviolet light, concrete or chemicals.

  Safe

  At Risk

  N/A

• Impact indicator - The impact indicator is a section of webbing that is secured with a special stitch pattern. It is designed to release when the harness has been subjected to impact loading from a fall. Prevent any future use by destroying and discarding the harness if the impact indicator is broken.

  Safe

  At Risk

  N/A

• Labels - Inspect labels, all labels should be intact and legible.

  Safe

  At Risk

  N/A

Inspector Approval: Specify in 'note' tab under overall disposition what pieces of equipment have either been inspected, and are safe for use, or have been destroyed and discarded.

• Overall Disposition

  Safe for use

  Destroyed and discarded