IM Safety Harness & Lanyard Inspection

• Site conducted

  Select

• EQ Type & Serial Number

  Select Lanyard Harness Tie-Off Adaptors/Anchorages Horizontal Lifelines

  • Lanyard
  • Harness
  • Tie-Off Adaptors/Anchorages
  • Horizontal Lifelines

• Serial Number

• Serial Number

• Date and Time of Inspection

  Date

• Inspected by

• Location
  Address

General Information

• Equipment Type

  Select Lanyard Harness Tie-Off Adaptors/Anchorages Horizontal Lifelines

  • Lanyard
  • Harness
  • Tie-Off Adaptors/Anchorages
  • Horizontal Lifelines

• Type of Lanyard

  Shock-Absorbing Lanyard

  Self-Retracting Lanyards

  Positioning Lanyards

• Does the legible tag identify the harness, model, date of manufacture, name of manufacturer, limitations and warnings

  Yes

  No

  N/A

• Take a photo of it

  Media

• Make, Lot # and Manufacturing Date

  Yes

  No

  N/A

• Nylon webbing is free of cuts, burn marks, and chemical damage

  Yes

  No

  N/A

• Webbing is free of tears, broken fibers, frayed edges, and pulled stitches

  Yes

  No

  N/A

• Lanyard webbing has no additional holes or less than 10% fray

  Yes

  No

  N/A

• Tongue/straps show no excessive wear from repeated buckling

  Yes

  No

  N/A

• Buckles/Snap Hooks/connectors in good condition

  Yes

  No

  N/A

• Does the legible tag identify the harness, model, date of manufacture, name of manufacturer, limitations and warnings

  Yes

  No

  N/A

• Take a photo of it

  Media

• Make, Lot # and Manufacturing Date

  Yes

  No

  N/A

• Nylon webbing is free of cuts, burn marks, and chemical damage

  Yes

  No

  N/A

• Webbing is free of tears, broken fibers, frayed edges, and pulled stitches

  Yes

  No

  N/A

• Harness webbing has no additional holes

  Yes

  No

  N/A

• D-rings are free of excessive wear, pits, deterioration, cracks, and sharp edges

  Yes

  No

  N/A

• D-rings pivot freely

  Yes

  No

  N/A

• Buckles are not deformed or cracked, and will operate correctly

  Yes

  No

  N/A

• All grommets are secure and not deformed

  Yes

  No

  N/A

• All rivets are tight and not deformed

  Yes

  No

  N/A

• Tongue/straps show no excessive wear from repeated buckling

  Yes

  No

  N/A

• Buckles/Snap Hooks/connectors in good condition

  Yes

  No

  N/A

• Tie-off adaptor is free of cuts, abrasions, burn marks, and chemical damage

  Yes

  No

  N/A

• Tie-off adaptor is free of tears, broken fibers, frayed edges, and pulled stitches

  Yes

  No

  N/A

• Tie-off adaptor is free of signs of deterioration, heat damage, and stretching

  Yes

  No

  N/A

• Unit was tested to verify that the locking mechanism is operating correctly

  Yes

  No

  N/A

• All labels are present, legible, and securely attached

  Yes

  No

  N/A

• Lifeline rope has no visible physical damage

  Yes

  No

  N/A

• All metallic parts for evidence of defects, damage, alteration, and missing parts

  Yes

  No

  N/A

• Description of work on which a safety harness and lanyard will be used

• Take a photo of the equipment

  Media

Recommendation

• Overall Rating

  Good

  Needs Repair

  Do Not Use

• Write down your recommendation

Completion

• Inspected by (Name and Signature)

  Sign