Information
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Add media
ITS Technologies & Logistics Monthly Inspections
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Self-Retracting Lifeline Fall Protection
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Division
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Location / Site
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GPS - Location
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For Month Of:
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Conducted on
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Prepared by - Full Name
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Employee Number
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Note: Each Self-Retracting Lifeline inspected - Must be completed and numbered accordingly to identify each individual inspection
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Item or Harness Number #
Checklist
ITS Technologies & Logistics Monthly Inspections
Self-Retracting Lifeline Fall Protection - Self Inspection Checklist
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Guidelines: Mark each item P for Pass or F for Fail. If any fails inspection remove from service and send in for repair and re-cert.
Self-Retracting Lifeline Inspections
Information
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USER
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Model
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Serial #
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Date Manufactured
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Length of Web or Cable
Comments - Corrective Action:
Housing
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1. Anchorage Point?<br>
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2. Nuts or Bolts or Rivets?<br>
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3. Swivels?<br>
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4. Evidence of Damage?<br>
Comments - Corrective Action:
Connectors & D-Ring(s)
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1. Function of Connector Gate & Lock?
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2. Impact Indicator?
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3. Body of Hook or Rivets?
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4. Corrosion?
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5. Pitting? (pitting as small indentation in a Surface)
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6. Nicks? (A Shallow notch, cut, or Indentation on edge or Surface)
Comments - Corrective Action:
Lifeline (Webbing, Cable, Synthetic)
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1. Termination (Stitch or Splice or Swage)?
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2. Cuts?
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3. Fraying?
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4. Excessive Wear?
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5. Cable Seperating?
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6. Entire Length Retracts Smoothly?
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7. Reserve Lifeline Deployed?
Comments - Corrective Action:
Shock Pack
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1. Integrity of Cover?
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2. Signs of Damage?
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3. Impact Incicator?
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4. Lanyard or Webbing Length?
Comments - Corrective Action:
Labels & Markings
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1. Legible Label?
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2. Appropriate ANSI/CSA/OSHA Markings?
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3. Date of 1st Use?
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4. Last Manufacturer Recertification?
