Self retracting lifeline inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Retracting lifeline information

• Model

• Manufacture date

• Serial number

• Purchase date

• Owner ID

General Factors

• Impact indicator: Inspect indicator for activation, rupture of red stitching, elongated. Is it acceptable?

  Safe

  At Risk

  N/A

• Screws and fasteners: Inspect for damage and make sure all fasteners are tight. Is this acceptable?

  Safe

  At Risk

  N/A

• Housing: Inspect for distortion, cracks, and other damage. Is it acceptable?

  Safe

  At Risk

  N/A

• Lifeline: Inspect for cuts, burns, tears, abrasions, frays, broken wires, excessive dirt and discoloration. Is it acceptable?

  Safe

  At Risk

  N/A

• Locking action: Inspect for proper lock-up of brake. Is this acceptable?

  Safe

  At Risk

  N/A

• Hooks and carabiners: Inspect for physical damage and distortion. Is it acceptable?

  Safe

  At Risk

  N/A

• Retracting and Extension: Pull lifeline out fully to inspect. Is it acceptable?

  Safe

  At Risk

  N/A

• Labels: Inspect to make sure all labels are legible and secured. Is it acceptable?

  Safe

  At Risk

  N/A

• Overall condition

  Safe

  At Risk

  N/A

• Add signature

  Sign