OMNI IPS Harness & Lanyard Inspection Report

• Conducted on

  Date

• Prepared by

• Location of Job

• Other equipment being used

• Item(s) being inspected

  Select Harness Lanyard Harness and lanyard

  • Harness
  • Lanyard
  • Harness and lanyard

Lanyard Type:

• Check Type of Lanyard

  Select 1m fixed 1.5M Fixed 2m fixed Adjustable Lanyard Self Retracting Other

  • 1m fixed
  • 1.5M Fixed
  • 2m fixed
  • Adjustable Lanyard
  • Self Retracting
  • Other

TYPE OF INSPECTION

• type of inspection

  Detailed pre use inspections

• Item(s) being inspected

  Select Harness Lanyard Harness and lanyard

  • Harness
  • Lanyard
  • Harness and lanyard

Harness:

• are you inspecting a harness

  Yes

  No

Harness info

• colour

• harness Serial No

• expiry date of certification

  Date

• Photo of harness labelling and tags

  Media

Harness Type:

• Check Type Harnesses Inspecting

  Select Full-Body Adjustable Harness Flame Retardant Welders Harness other

  • Full-Body Adjustable Harness
  • Flame Retardant Welders Harness
  • other

• Details of other

• Areas checked

  Select Fraying Weld Burns Cuts Excessive Wear Stitching Rivets Eyelets D-Rings Buckles Body Pad Data Tag (Certification data present & legible

  • Fraying
  • Weld Burns
  • Cuts
  • Excessive Wear
  • Stitching
  • Rivets
  • Eyelets
  • D-Rings
  • Buckles
  • Body Pad
  • Data Tag (Certification data present & legible

Defects

• were any defects found?

  Select Yes No

  • Yes
  • No

• Description of defects found

• Take photos of any defects found

• Can the Item remain in service?

  Yes

  No

Lanyards

This inspection MUST be completed by an independent inspector (NOT the user )

• This inspection is being completed by an independent inspector (NOT the user )

• Manufacturer

• expiry date of certification

  Date

• Photo of harness labelling and tags

  Media

Lanyard Type:

• Check Type of Lanyard

  Select 1m fixed 1.5M Fixed 2m fixed Adjustable Lanyard Self Retracting Other

  • 1m fixed
  • 1.5M Fixed
  • 2m fixed
  • Adjustable Lanyard
  • Self Retracting
  • Other

• Items checked

  Select Excessive Wear Fraying Cuts Weld Burns Deteriorate Safety Latch Hook D-Rings Data Tag (Certification data present & legible)

  • Excessive Wear
  • Fraying
  • Cuts
  • Weld Burns
  • Deteriorate
  • Safety Latch Hook
  • D-Rings
  • Data Tag (Certification data present & legible)

Defects

• were any defects found?

  Yes

  No

• Description of defects found

• Take photos of any defects found

• Can the Lanyard remain in service?

  Yes

  No

• Yes

  No

Lanyard

• Is this a lanyard inspection

  Yes

  No

Lanyard

• colour

• Lanyard Serial No

• Manufacturer

• expiry date of certification

  Date

• Photo of harness labelling and tags

  Media

• Reference numbers or last 4 numbers of the serial numbers on the harness/lanyard

• details of the pre use inspection

  Pass

  Fail

• details of actions taken

• Item must be withdrawn form service

• Item(s) being inspected

  Harness

  Lanyard

  Harness and lanyard

Items checked

• Items checked

  Select Excessive Wear Fraying Cuts Weld Burns Deteriorate Safety Latch Hook D-Rings Data Tag (Certification data present & legible)

  • Excessive Wear
  • Fraying
  • Cuts
  • Weld Burns
  • Deteriorate
  • Safety Latch Hook
  • D-Rings
  • Data Tag (Certification data present & legible)

Defects

• were any defects found?

  Yes

  No

• Description of defects found

• Take photos of any defects found

Items checked

• Items checked

  Select Excessive Wear Fraying Cuts Weld Burns Deteriorate Safety Latch Hook D-Rings Data Tag (Certification data present & legible)

  • Excessive Wear
  • Fraying
  • Cuts
  • Weld Burns
  • Deteriorate
  • Safety Latch Hook
  • D-Rings
  • Data Tag (Certification data present & legible)

Defects

• were any defects found?

  Yes

  No

• Description of defects found

• Take photos of any defects found

Items checked

• Items checked

  Select Excessive Wear Fraying Cuts Weld Burns Deteriorate Safety Latch Hook D-Rings Data Tag (Certification data present & legible)

  • Excessive Wear
  • Fraying
  • Cuts
  • Weld Burns
  • Deteriorate
  • Safety Latch Hook
  • D-Rings
  • Data Tag (Certification data present & legible)

Defects

• were any defects found?

  Yes

  No

• Description of defects found

• Take photos of any defects found

• Can the Item(s) remain in service?

  Yes

  No

  N/A

• Please detail the actions taken

• Is the equipment safe for use

  Yes

  No

• Inspectors Signature:

  Sign