Title Page
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Conducted on
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Prepared by
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Location
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Name of person to whom it is issued.
Safety Harness
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Does this inspection include a safety harness
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Serial Number
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Name of Manufacturer
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Type of harness
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Date of Manufacture / latest LOLER Inspection
Buckles and Adjusters - please take photo to demonstrate condition and note any defects and actions
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All buckles and adjuster is visible and free from dirt, grease or other residues
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There is no visible signs of rust or corrosion
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There is no visible signs of deformity or metal bend damaged or have burs/ cracks
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Buckles and adjusters function effectively
Webbing
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All webbing is free from dirt, grease or other residues
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Webbing has no holes, cuts, burns or damage
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Webbing is in good condition and free of excessive wear
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No other defect which could affect the affect the protection to wearer
Stitching
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All stitching is visible and free from dirt, grease or other residues
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All stitching is in tact and in good order check all locations on harness
Tags
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ID label is in tack and clear
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LOLER inspection tag present or conformity certificate attached and less than 12 months old
other issues
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provide information of any other issues
Pole Belt
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Does the Inspection include a Pole Belt
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Serial Number
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Name of Manufacturer
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Type of Pole Belt
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Date of Manufacture / latest LOLER Inspection
Buckles and Adjusters
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All buckles and adjuster is visible and free from dirt, grease or other residues
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There is no visible signs of rust or corrosion
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There is no visible signs of deformity or metal bend damaged or have burs/ cracks
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Buckles and adjusters function effectively
Clip and Karabiners
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There is no visible signs of rust or corrosion
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There is no visible signs of deformity or metal bend damaged or have burs/ cracks
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Clips and karabiners are fully functioning and locking securely
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All clips and karabiners is visible and free from dirt, grease or other residues
Webbing
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All webbing is free from dirt, grease or other residues
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Webbing has no holes, cuts, burns or damage
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Webbing is in good condition and free of excessive wear
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No other defect which could affect the affect the protection to wearer
Stitching
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All stitching is visible and free from dirt, grease or other residues
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All stitching is in tact and in good order check all locations on harness
Tags
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LOLER inspection tag present or conformity certificate attached and less than 12 months old
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ID label is in tack and clear
other
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Provide details of any other issues
Lanyard
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Does the inspection include a lanyard
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Serial Number
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Name of Manufacturer
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Type of Lanyard
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Date of Manufacture / latest LOLER Inspection
Clips and Karabiners
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Clips and karabiners are fully functioning and locking securely
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There is no visible signs of rust or corrosion
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There is no visible signs of deformity or metal bend damaged or have burs/ cracks
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All clips and karabiners is visible and free from dirt, grease or other residues
Webbing
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All webbing is free from dirt, grease or other residues
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Webbing has no holes, cuts, burns or damage
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Webbing is in good condition and free of excessive wear
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Free from knots, twists or distortions
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No other defect which could affect the affect it working effectively if deployed
Shock Pack
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Shock absorber cover in good order and no sign of damage
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No damage , fraying or broken stitching
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No evidence of previous deployment
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No other defect which could affect the affect it working effectively if deployed
Stitching
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All stitching is visible and free from dirt, grease or other residues
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All stitching is in tact and in good order check all locations on harness
tags
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ID label is in tack and clear
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LOLER inspection tag present or conformity certificate attached and less than 12 months old
other Issues
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Provide details of any other issues
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Signature of inspector
