Safety Harness & Rope - Maintenance Record

• Site conducted

  Select

• Conducted on

  Date
• Location
  Address

• Harness Number

• Harness Brand

• Labels in place

  Yes

  No

  N/A

• Cuts or tears

  Yes

  No

  N/A

• Abrasion damage

  Yes

  No

  N/A

• Excessive stretching

  Yes

  No

  N/A

• Corrosive or solvent damage

  Yes

  No

  N/A

• Deterioration due to rotting or mildew

  Yes

  No

  N/A

• Sunlight damage

  Yes

  No

  N/A

• Check all snap hooks

  Yes

  No

  N/A

• Check D-rings and metal components

  Yes

  No

  N/A

• Check buckles and adjusters

  Yes

  No

  N/A

• Is the harness clean

  Yes

  No

  N/A

• Date of last test by competent person

  Date

• Passed inspection

  Pass

  Fail

  N/A

Safety Rope Inspection

• Is the rope in a serviceable condition

  Yes

  No

  N/A

• Is the rope safe to use

  Safe

  At Risk

  N/A

Ventilation Fan Inspection

• Is the ventilation fan in a serviceable condition

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Is the ventilation fan safe to use

  Safe

  At Risk

  N/A

Safe to proceed

• Inspection completed by

  Select

• Safe to proceed

  Safe

  At Risk

  N/A

• Signature

  Sign