NEW Self Retracting Lifelines

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

Retracting Lifeline Information

• Model

• Serial Number

• Lot Number

• Manufacture Date

• Department/Loction

Retracting Lifeline Inspection

• Impact Indicator

  Safe

  At Risk

  N/A

• Screws/Fasteners

  Safe

  At Risk

  N/A

• Housing

  Safe

  At Risk

  N/A

• Lifeline

  Safe

  At Risk

  N/A

• Locking Action

  Safe

  At Risk

  N/A

• Retraction/Extension

  Safe

  At Risk

  N/A

• Hooks/Carabiniers

  Safe

  At Risk

  N/A

• Reverse Lifeline

  Safe

  At Risk

  N/A

• Labels

  Safe

  At Risk

  N/A

Retracting Lifeline Approval

• Overall Disposition

  Safe

  At Risk

  N/A

• Inspected By

  Sign