IPS Harness / Lanyard Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Labels:

• Label Attached to Harness<br>

  Yes

  No

• Label Fully Legible

  Legible

  Illegible

• HARNESS Date of Manufacture:

• HARNESS Serial #

• HARNESS Model #

• LANYARD Date of Manufacture:

• LANYARD Serial #

• LANYARD Model #

Hardware:

• Buckles in Place?

  Yes

  No

  N/A

• D Rings in Place?

  Yes

  No

  N/A

• Back Pad in Place?

  Yes

  No

  N/A

• Loop Keepers in Place?

  Yes

  No

  N/A

Hardware Condition:

• Free from Damaged or Worn Parts?

  Excellent

  Good

  Poor

  Removed from service

• Free from Broken or Bent Parts?

  Excellent

  Good

  Poor

  Removed from service

• Buckle springs in working order

  Excellent

  Good

  Poor

  Removed from service

• Free from sharp edges

  Excellent

  Good

  Poor

  Removed from service

• Free from Burrs?

  Excellent

  Good

  Poor

  Removed from service

• Free from Cracks?

  Excellent

  Good

  Poor

  Removed from service

• Free from Parts Distorted or Out of Shape?

  Excellent

  Good

  Poor

  Removed from service

• Free from Corrosion?

  Excellent

  Good

  Poor

  Removed from service

Webbing:

• Free from frays

  Excellent

  Good

  Poor

  Removed from service

• Webbing free from cuts

  Excellent

  Good

  Poor

  Removed from service

• Free from Broken Fibers?

  Excellent

  Good

  Poor

  Removed from service

• Free from Broken Stiches?

  Excellent

  Good

  Poor

  Removed from service

• Free fromTears?

  Excellent

  Good

  Poor

  Removed from service

• Free from Abrasions?

  Excellent

  Good

  Poor

  Removed from service

• Free from Mold?

  Excellent

  Good

  Poor

  Removed from service

• Free from Burns?

  Excellent

  Good

  Poor

  Removed from service

• IF INSPECTION REVEALS ANY DEFECTIVE CONDITION, REMOVE FROM SERVICE AND DESTROY.

• Signature of Inspector

  Sign