• Client / Site

  • Conducted on

  • Inspected By

  • Location
  • Harness Worn By


  • Harness Serial Number

  • Date of Manufacture


  • Shoulder Strap

  • Stitching

  • Buckles

  • Adjustable Roller Buckles

  • Leg Strap

  • D - Rings

  • D-Ring Back Pad

  • Sub-Pelvic Strap

  • Belt Keeper

  • CSA Product Labels

  • Back Strap

  • Fall Indicator


  • 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.


  • 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.

  • 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.


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


  • Harness is approved for use at time of inspection.

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.