Safety Equipment Quarterly Inspection Form - Technician

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• DATE / TIME OF INSPECTION:

  Date

• SUPERVISOR / INSPECTOR NAME:

• TECHNICIAN NAME / ID:

• VEHICLE PLATE / UNIT #

LADDERS

Ladder General

• Side Rails - Free from cracks, dents, bends or blemishes

  Safe

  At Risk

  N/A

• Rungs/Steps - Ensure tightness and no rotation - Free from sharp edges

  Safe

  At Risk

  N/A

• Fasteners - Rivets, nuts and bolts are tight

  Safe

  At Risk

  N/A

• Feet - Look for wear or loose rivets

  Safe

  At Risk

  N/A

• Appearance - Cracks and exposed fibreglass - Corrosion, rust, oxidization and excessive wear

  Safe

  At Risk

  N/A

Step Ladders

• Top Cap - Free from cracks and dents

  Safe

  At Risk

  N/A

• Spreader Arms - Tight and move freely - Broken stop on a hinge spreader

  Safe

  At Risk

  N/A

• Horizontal Braces - Ensure tightness

  Safe

  At Risk

  N/A

• Step Braces - Ensure tightness

  Safe

  At Risk

  N/A

• Pail Tray - Moves freely, is tight and sets up properly

  Safe

  At Risk

  N/A

Extension Ladders

• End Caps - Tight and free from cracks, chips or wear

  Safe

  At Risk

  N/A

• Rope And Pulley - Ensure rope is not frayed or knotted

  Safe

  At Risk

  N/A

• Gravity Locks - Ensure they pivot freely and fingers in good working condition

  Safe

  At Risk

  N/A

• Slide Guides - Free from cracks, chips or wear

  Safe

  At Risk

  N/A

• Base And Fly Section - Ensure they are straight and not warped

  Safe

  At Risk

  N/A

HARD HATS

Shell - Do not continue use if any of the below are visible

• Free from dents, cracks, penetration, abrasion, rough treatment

  Safe

  At Risk

  N/A

• Ensure there is no damage due to impact

  Safe

  At Risk

  N/A

• Are there any unauthorized alterations?

  Safe

  At Risk

  N/A

• Does it appear to have any fading, dull color or chalky appearance?

  Safe

  At Risk

  N/A

• Does the shell appear to be stiff or brittle?

  Safe

  At Risk

  N/A

Suspension

• Look for any cracks or tears

  Safe

  At Risk

  N/A

• Suspension straps should be free of any cuts or fraying

  Safe

  At Risk

  N/A

• Should be pliable and not show any signs or wear

  Safe

  At Risk

  N/A

• All points in the suspension should fit tightly in their respective slots

  Safe

  At Risk

  N/A

FALL PROTECTION EQUIPMENT

Harness And/Or Body Belt

• Instructions: Grasp the webbing with your hands 6-8 inches apart. Bend the webbing in an inverted "U". The surface tension makes damaged fibers or cuts easier to detect. Follow this procedure the entire length of the webbing, inspecting both sides.

• Webbing - Look for frayed edges, broken fibers, pulled stitches, cuts, burns and chemical damage

  Safe

  At Risk

  N/A

• D-Rings - Check for distortion, cracks, breaks, and rough or sharp edges

  Safe

  At Risk

  N/A

• Attachment Of Buckles - Inspect for any wear, frayed or cut fibers, broken stitching of the buckles or D-ring attachments

  Safe

  At Risk

  N/A

• Tongue/Grommets - Inspect for loose, distorted or broken grommets. Webbing should not have additional punched holes

  Yes

  No

  N/A

• Tongue And/Or Quick Connect Buckles - Should be free of distortion in shape and motion. They should overlap the buckle frame and move freely back and forth in their socket. Roller should turn freely on frame

  Safe

  At Risk

  N/A

• Friction And Mating Buckles - Inspect the buckle for distortion, outer bars and center bar must be straight

  Safe

  At Risk

  N/A

• Stitching - Check for ripped or pulled stitches and make sure the webbing joints are not loose

  Safe

  At Risk

  N/A

Lanyard

• Snaps - Inspect for hook and eye distortions, cracks, corrosion, or pitted surfaces. The latch should seat into the nose without binding and should not be distorted or obstructed. The latch spring should exert sufficient force to close the latch. Latch locks must prevent the latch from opening when it closes

  Safe

  At Risk

  N/A

• Thimbles - Must be firmly seated in the eye of the splice, and the splice should have no loose or cut strands. The edges of the thimbles must be free of sharp edges, distortion or cracks

  Safe

  At Risk

  N/A

• Wen Lanyard - While bending webbing over a pipe, observe each side of the webbed lanyard. This will reveal any cuts or breaks. Swelling, discoloration, cracks and charring are obvious signs of chemical or heat damage. Observe closely for any breaks in stitching

  Safe

  At Risk

  N/A

• Rope Lanyard - Rotate the rope lanyard while inspecting from end-to-end for any fuzzy, worn, broken or cut fibers. The rope diameter should be uniform throughout, following a short break-in period

  Safe

  At Risk

  N/A

• Shock Absorbing Lanyard - Lanyards should be examined as described above. However also look for the warning flag or signs of deployment. If the flag has been activated, remove lanyard from service

  Safe

  At Risk

  N/A

VEHICLE/GENERAL INSPECTION ITEMS

General Safety Items

• First Aid Kit - Available in vehicle and fully stocked

  Yes

  No

  N/A

• Fire Extinguisher - Inspected/signed regularly and in good condition

  Yes

  No

  N/A

• Safety Boots - CSA approved, height requirements for both ankle and heel, no holes, laced up

  Yes

  No

  N/A

• Safety Glasses - Stocked

  Yes

  No

  N/A

• Work Gloves - Stocked

  Yes

  No

  N/A

• Voltage Detector - Charged and working

  Yes

  No

  N/A

• Safety Vest - Stocked

  Yes

  No

  N/A

Vehicle Safety Items

• Wheel Chalks - Stocked

  Yes

  No

  N/A

• Beacon Light - Installed and operational

  Yes

  No

  N/A

• Traffic Cones (4-6) - Stocked

  Yes

  No

  N/A

• Flags or Flares - Stocked

  Yes

  No

  N/A

• Manhole Guards - Stocked

  Yes

  No

  N/A

• Manhole Ventilator - Stocked

  Yes

  No

  N/A

• BW Microclip - Gas Detector - Date of last calibration

  Safe

  At Risk

  N/A

• Bucket Truck Level Indicator - Inclinometer - Operational

  Yes

  No

  N/A

• Technician Signature:

  Sign

• Supervisor/Inspector Signature:

  Sign