Title Page
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Employee Name:
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Drivers License Expiration Date:
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DOT Physical Expiration Date:
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Inspected by:
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Conducted on:
General Inspection
Climbing Belts:
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Leather:
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D-Rings:
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Metal Body Contacts:
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Rivets:
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Sewing/Lacing:
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Tool Loop:
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Back Saver:
Bucket Ladder:
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Truck #:
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Date In Service:
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Clean:
Harness:
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Physical Condition:
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Date In Service:
Lanyard:
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Physical Condition:
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Size:
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Date In Service:
Hard Hat:
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Physical Condition:
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Hat Liner:
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Chin Strap:
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ANSI/Approved Sticker:
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Date In Service:
Misc Clothing:
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FR Safety Vest:
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FR Rain Gear:
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Chaps:
Eye Protection:
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Safety Glasses:
Hearing Protection:
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Physical Condition:
Rubber Gloves & Sleeves:
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Gloves Test Date:
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Sleeves Test Date:
Hand Tools:
Hammers:
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Head/Handle:
Wrenches:
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Physical Condition:
Screwdrivers:
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Handles/Blades:
Pliers:
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Jaws/Handles:
Rulers:
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Physical Condition:
Other:
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Other:
Climbing Gear Inspection
Climbers:
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Gaffs:
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Clean/Flexible:
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Holes/Enlarged:
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Rivets/Sewing:
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Buckles:
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Pouches:
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Canvas Bag:
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Tools Stored Properly & Clean
Supervisor
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Supervisor Signature:
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Today's Date:
