Self Retracting Lifeline Inspection Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Inspected By

  Select Aaron Sherfield Marcus Bryant Ray Knapp Bill Tarasi Melvin Harris Eric Hargreaves Adan Molina Travis Ferguson Jeremy Yager Other

  • Aaron Sherfield
  • Marcus Bryant
  • Ray Knapp
  • Bill Tarasi
  • Melvin Harris
  • Eric Hargreaves
  • Adan Molina
  • Travis Ferguson
  • Jeremy Yager
  • Other

• Condition

  New

  Used

• Manufacturer

  Select Miller DBI Fall Tech Guardian MSA 3M Other

  • Miller
  • DBI
  • Fall Tech
  • Guardian
  • MSA
  • 3M
  • Other

• MCC Unit Number

• Take photo of tag or enter info below

  Media

• Date of Manufacture

  Date

• Model

• Serial #

Housing/Cover

• Ensure casing bolts are tight

  Safe

  At Risk

  N/A

• Loose fasteners

  Safe

  At Risk

  N/A

• Missing parts

  Safe

  At Risk

  N/A

• Cracks or wear

  Safe

  At Risk

  N/A

• No deformation at connecting areas

  Safe

  At Risk

  N/A

• Corrosion

  Safe

  At Risk

  N/A

• Overall deterioration

  Safe

  At Risk

  N/A

• Modification by user

  Safe

  At Risk

  N/A

• Physical damage

  Safe

  At Risk

  N/A

• Bent, cracked, distorted, worn or malfunctioning parts

  Safe

  At Risk

  N/A

Snap Hooks

• Distortion (twist/bends)

  Safe

  At Risk

  N/A

• Rust or corrosion

  Safe

  At Risk

  N/A

• Modifications by users

  Safe

  At Risk

  N/A

• Rough or sharp edges

  Safe

  At Risk

  N/A

• Latch/keeper seated in nose properly without binding

  Safe

  At Risk

  N/A

• Latch/ keeper is not distorted or obstructed

  Safe

  At Risk

  N/A

• Overall deterioration/excessive wear

  Safe

  At Risk

  N/A

• No cracks

  Safe

  At Risk

  N/A

• No missing parts

  Safe

  At Risk

  N/A

• Locking mechanism working properly

  Safe

  At Risk

  N/A

• Snap Hook keeper mechanism is working properly

  Safe

  At Risk

  N/A

Tagging System

• Is tag present and legible

  Safe

  At Risk

  N/A

Wire Rope

• Cuts, frayed areas

  Safe

  At Risk

  N/A

• Worn or broken strands/wires

  Safe

  At Risk

  N/A

• Overall deterioration/ excessive outside wear

  Safe

  At Risk

  N/A

• Modifications by the user

  Safe

  At Risk

  N/A

• Rust/pitting/corrosion

  Safe

  At Risk

  N/A

• Crushed/jammed or flattened strands

  Safe

  At Risk

  N/A

• Bulges in the rope

  Safe

  At Risk

  N/A

• Gaps between strands

  Safe

  At Risk

  N/A

• Heat damage, torch burns or electric arc strikes

  Safe

  At Risk

  N/A

• Kinks, bird caging

  Safe

  At Risk

  N/A

• Core protrusion

  Safe

  At Risk

  N/A

Tests

• Braking Test

  Pass

  Fail