Title Page
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Document No.
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Audit Title
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Client / Site
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Date Inspected
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Inspected By:
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Location
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Personnel
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Full Body Harness
Harness
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Harness Model:
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Manufacture Date:
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Serial Number:
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Lot Number:
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Purchase Date:
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Hardware: (Includes D-rings, buckles, keepers and back pads) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.
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Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.
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Stitching: Inspect for pulled or cut stitches.
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Labels: Inspect, make certain all labels are securely held in place and legible.
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Lanyards
Lanyard
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Lanyard Model:
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Manufacture Date:
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Serial Number:
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Lot Number:
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Purchase Date:
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Hardware: (Includes snap hooks, carabiners, adjusters, keepers, thimbles and D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, corrosion and proper operation.
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Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.
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Stitching: Inspect for pulled or cut stitches.
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Synthetic Rope: Inspect for pulled or cut yarns, burns, abrasion, knots, excessive soiling and discoloration.
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Wire Rope: Inspect for broken wires, corrosion, kinks and separation of strands.
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Energy Absorbing Component: Inspect for elongation, tears and excessive soiling.
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Labels: Make certain all labels are securely held in place and legible.
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Overall Disposition
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Self Retracting Lifelines
Self Retracting Lifeline
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Self Retracting Lifeline Model:
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Manufacture Date:
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Serial Number:
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Lot Number:
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Purchase Date:
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Impact Indicator: Inspect indicator for activation (rupture of red stitching, elongated indicator, etc.)
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Screws / Fasteners: Inspect for damage and make certain all screws and fasteners are tight.
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Housing: Inspect for distortion, cracks and other damage. Inspect anchoring loop for distortion and damage.
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Lifeline: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration, broken wires (see impact indicator section).
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Locking Action: Inspect for proper lock-up of brake mechanism.
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Retraction/Extension: Inspect spring tension by pulling lifeline out fully and allowing it to retract fully (no slack).
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Hooks / Carabiners: Inspect for physical damage, corrosion, proper operation and markings (see separate checklist/log for hooks and carabiners).
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Reserve Lifeline: Inspect reserve lifeline retention systems for deployment.
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Labels: Inspect, make certain all labels are securely held in place and legible.
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Overall Disposition
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Tie-Off Adapters
Tie-Off Adapter
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Tie-Off Adapter Model:
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Manufacture Date:
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Serial Number:
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Lot Number:
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Purchase Date:
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Hardware: (Includes D-rings) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.
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Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.
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Stitching: Inspect for pulled or cut stitches.
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Labels: Inspect, make certain all labels are securely held in place and legible.
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Overall Disposition
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Hooks / Carabiners
Hook / Carabiner
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Hooks / Carabiners Model:
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Manufacture Date:
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Serial Number:
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Lot Number:
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Purchase Date:
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Physical Damage: Inspect for cracks, sharp edges, burrs, deformities and locking operation.
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Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.
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Markings: Inspect, make sure certain marking(s) are legible.
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Overall Disposition
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Anchorage Plates
Anchorage Plate
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Anchorage Plate Model:
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Manufacture Date:
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Serial Number:
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Lot Number:
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Purchase Date:
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Physical Damage: Inspect for cracks, sharp edges, burrs and deformities
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Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.
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Fasteners: Inspect for corrosion, tightness, damage and distortion. If welded, inspect weld for corrosion, cracks and damage.
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Markings: Inspect, make sure certain marking(s) are legible.
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Overall Disposition
