HARNESS INSPECTION

• Client / Site

• Conducted on

  Date

• Inspected By

• Location
  Address

• Harness Worn By

HARNESS IDENTIFICATION

• Harness Serial Number

• Date of Manufacture

NAME/DESCRIPTION PART INSPECTED

• Shoulder Strap

  Pass

  Fail

  N/A

• Stitching

  Pass

  Fail

  N/A

• Buckles

  Pass

  Fail

  N/A

• Adjustable Roller Buckles

  Pass

  Fail

  N/A

• Leg Strap

  Pass

  Fail

  N/A

• D - Rings

  Pass

  Fail

  N/A

• D-Ring Back Pad

  Pass

  Fail

  N/A

• Sub-Pelvic Strap

  Pass

  Fail

  N/A

• Belt Keeper

  Pass

  Fail

  N/A

• CSA Product Labels

  Pass

  Fail

  N/A

• Back Strap

  Pass

  Fail

  N/A

• Fall Indicator

  Pass

  Fail

  N/A

HARDWARE

• D-rings<br>Check D-rings for rust or corrosion (>10% coverage), distortion, cracks, breaks, bends, dents, nicks and rough or sharp edges. D-rings should pivot freely.

  Safe

  At Risk

  N/A

STRAP, WEBBING, STITCHING

• Straps (Shoulders, Leg Loops, Front and Back) & Webbing<br>Inspect the entire length of all the webbing looking for frayed edges, broken fibers, pulled stitches, cuts, burns and chemical damage. Also look for mildew, discoloration, hard shiny spots, any webbing that has been marked with a felt pen, excessive hardness or brittleness or the Harness Fall Indicator deployment.

  Safe

  At Risk

  N/A

• Stitching <br>Check all stitching for ripped or pulled stitches and to make sure the webbing joints are not loose. Also look for missing stitching, hard or shiny spots, or discoloration of stitching.

  Safe

  At Risk

  N/A

LABELS

• Inspect to be certain that all harnesses have a label that is legible and securely held in place.

  Yes

  No

  N/A

OVERALL DISPOSITION

• Harness is approved for use at time of inspection.

  Yes

  No

  N/A

• Add signature

  Sign