Information
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Cooperative Name?
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Date of Inspection?
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Auditor Name?
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Who is the equipment user?
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Who is the equipment assigned to?
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Is this equipment assigned to a specific vehicle? If so, what is the vehicle number?
Harness Information
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What is the harness serial number?
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What is the harness size?
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Is the harness free of any tears or rips?
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What is the condition of the straps?
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What is the condition of the buckles?
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What is the condition of the D ring?
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What is the condition of the label(s)?
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What is the overall condition of the harness?
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Lanyard Information
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What is the lanyard serial number?
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What type of lanyard?
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What is the length of lanyard?
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What is the condition of the hook?
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Is the lanyard free of tears or rips?
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What is the condition of the carabiner?
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Self Retracting Lifeline
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What is the serial number of the self retracting lifeline?
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What is the length of the self retracting lanyard?
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What is the condition of the hook?
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What is the condition of the cable?
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What is the condition of the carabiner?
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Auditor Verification Signature
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