Personal Fall Protection Inspection 1.0

Information

FULL BODY HARNESS

HARNESS INFORMATION AVAILABLE
HARNESS MODEL #:
MANUFACTURE DATE:
SERIAL NUMBER:
LOT NUMBER:
PURCHASE DATE IF AVAILABLE:
COMMENTS:
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.
OVERALL DISPOSITION:
INSPECTED BY:

LANYARD INFORMATION AVAILABLE
LANYARD MODEL #:
MANUFACTURE DATE:
SERIAL NUMBER:
LOT NUMBER:
PURCHASE DATE IF AVAILABLE:
COMMENTS:
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.
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: Inspect, make certain all labels are securely held in place and legible.
OVERALL DISPOSITION:
INSPECTED BY:

HOOK/CARABINER INFORMATION AVAILABLE
HOOK/CARABINER MODEL #:
MANUFACTURE DATE:
SERIAL NUMBER:
LOT NUMBER:
PURCHASE DATE IF AVAILABLE:
COMMENTS:
PHYSICAL DAMAGE: Inspect for crack, sharp edges, burrs, deformities, and locking operation.
EXCESSIVE CORROSION: Inspect for corrosion which effects the operation and/or strength.
MARKINGS: Inspect, make certain marking(s) are legible.
OVERALL DISPOSITION:
INSPECTED BY:

TIE-OFF ADAPTOR INFORMATION AVAILABLE
TIE-OFF ADAPTOR MODEL #:
MANUFACTURE DATE:
SERIAL NUMBER:
LOT NUMBER:
PURCHASE DATE IF AVAILABLE:
COMMENTS:
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:
INSPECTED BY:

ANCHORAGE PLATE INFORMATION AVAILABLE
ANCHORAGE PLATE MODEL #:
MANUFACTURE DATE:
SERIAL NUMBER:
LOT NUMBER:
PURCHASE DATE IF AVAILABLE:
COMMENTS:
PHYSICAL DAMAGE: Inspect for crack, sharp edges, burrs, deformities, and locking operation.
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 certain marking(s) are legible.
OVERALL DISPOSITION:
INSPECTED BY:

SELF-RETRACTING LIFELINE INFORMATION AVAILABLE
SELF RETRACTING LIFELINE MODEL #:
MANUFACTURE DATE:
SERIAL NUMBER:
LOT NUMBER:
PURCHASE DATE IF AVAILABLE:
OWNER/DEPARTMENT/LOCATION:
OWNER'S IDENTIFICATION #: (Tool Room #)
COMMENTS:
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, discoloration and 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 & carabiners).
LABELS: Inspect, make certain all labels are securely held in place and legible.
OVERALL DISPOSITION:
RESERVE LIFELINE: Inspect reserve lifeline retention systems for deployment.
LABELS: Inspect, make certain all labels are securely held in place and legible.
INSPECTED BY: