Title Page
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Inspectors Name
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Date
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Location
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Owner
Lanyard Inspection
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Make
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Model
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Image of lanyard
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Serial number
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Image of serial number
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Date of manufacturer
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Additional notes or description
Buckles
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Is a buckle fitted to the lanyard?
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Inspected
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Pass/fail
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Pass/fail
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Detail failure
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Photo of failure
Webbing
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Inspected
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Pass/fail
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Detail failure
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Photo of failure
Stitching
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Inspected
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Pass/fail
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Detail failure
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Photo of failure
Labels
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inspected
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Pass/fail
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Detail failure
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Photo of failure
Confirmation of condition
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Lanyard is in a satisfactory to be used
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Detail reason for failure
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Detail re-check date
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Confirmation any failed items have been taken out of service
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Inspectors signature
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Detail why and confirm you accept all responsibility as the inspector for any consequences from using the equipment
