Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Date Inspected

  • Inspected By:

  • Location
  • Personnel

  • Full Body Harness

  • Harness
  • Harness Model:

  • Manufacture Date:

  • Serial Number:

  • Lot Number:

  • Purchase Date:

  • Hardware: (Includes D-rings, buckles, keepers and back pads) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.

  • Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.

  • Stitching: Inspect for pulled or cut stitches.

  • Labels: Inspect, make certain all labels are securely held in place and legible.

  • Lanyards

  • Lanyard
  • Lanyard Model:

  • Manufacture Date:

  • Serial Number:

  • Lot Number:

  • Purchase Date:

  • Hardware: (Includes snap hooks, carabiners, adjusters, keepers, thimbles and D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, corrosion and proper operation.

  • Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.

  • Stitching: Inspect for pulled or cut stitches.

  • Synthetic Rope: Inspect for pulled or cut yarns, burns, abrasion, knots, excessive soiling and discoloration.

  • Wire Rope: Inspect for broken wires, corrosion, kinks and separation of strands.

  • Energy Absorbing Component: Inspect for elongation, tears and excessive soiling.

  • Labels: Make certain all labels are securely held in place and legible.

  • Overall Disposition

  • Self Retracting Lifelines

  • Self Retracting Lifeline
  • Self Retracting Lifeline Model:

  • Manufacture Date:

  • Serial Number:

  • Lot Number:

  • Purchase Date:

  • Impact Indicator: Inspect indicator for activation (rupture of red stitching, elongated indicator, etc.)

  • Screws / Fasteners: Inspect for damage and make certain all screws and fasteners are tight.

  • Housing: Inspect for distortion, cracks and other damage. Inspect anchoring loop for distortion and damage.

  • Lifeline: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration, broken wires (see impact indicator section).

  • Locking Action: Inspect for proper lock-up of brake mechanism.

  • Retraction/Extension: Inspect spring tension by pulling lifeline out fully and allowing it to retract fully (no slack).

  • Hooks / Carabiners: Inspect for physical damage, corrosion, proper operation and markings (see separate checklist/log for hooks and carabiners).

  • Reserve Lifeline: Inspect reserve lifeline retention systems for deployment.

  • Labels: Inspect, make certain all labels are securely held in place and legible.

  • Overall Disposition

  • Tie-Off Adapters

  • Tie-Off Adapter
  • Tie-Off Adapter Model:

  • Manufacture Date:

  • Serial Number:

  • Lot Number:

  • Purchase Date:

  • Hardware: (Includes D-rings) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.

  • Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.

  • Stitching: Inspect for pulled or cut stitches.

  • Labels: Inspect, make certain all labels are securely held in place and legible.

  • Overall Disposition

  • Hooks / Carabiners

  • Hook / Carabiner
  • Hooks / Carabiners Model:

  • Manufacture Date:

  • Serial Number:

  • Lot Number:

  • Purchase Date:

  • Physical Damage: Inspect for cracks, sharp edges, burrs, deformities and locking operation.

  • Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.

  • Markings: Inspect, make sure certain marking(s) are legible.

  • Overall Disposition

  • Anchorage Plates

  • Anchorage Plate
  • Anchorage Plate Model:

  • Manufacture Date:

  • Serial Number:

  • Lot Number:

  • Purchase Date:

  • Physical Damage: Inspect for cracks, sharp edges, burrs and deformities

  • Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.

  • Fasteners: Inspect for corrosion, tightness, damage and distortion. If welded, inspect weld for corrosion, cracks and damage.

  • Markings: Inspect, make sure certain marking(s) are legible.

  • Overall Disposition

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.