Information
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Client / Site
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Address
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Conducted on
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Equipment being inspected
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Prepared by
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Department/Location
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Photo of Equipment
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Date of Inspection
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Serial #
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Model #
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Manufactured By:
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D.O.M.
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In Service Date
Impact Indicator ( where applicable)
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Damaged
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Deployed
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Buckles
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Damaged
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Corroded
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Cracked
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Burrs/Sharp Edges
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Bent/Distorted
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Labels
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Attached and Readable
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Plastic Keepers
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Missing
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Damaged
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Stitching
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Cuts
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Broken
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Burned
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Missing Stitch Patterns
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Webbing
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Frayed
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Cuts/Tearing/Holes
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Burns
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Knots
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UV Damage
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Discoloration
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Paint
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Grease/Grime
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Missing/Damaged Stitch Pattern
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Abrasion
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Heat Damage/Glazing
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Mold
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D-Ring
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Sharp Edges
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Cracked
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Welded
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Corroded
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Bent
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D-Ring Plate
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Missing
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Damaged
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Final Appraisal
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Fall Protection Status PASS/FAIL
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COMMENTS
