Self Retracting Lifeline Inspection - SRL Rev 8/20

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Info

• Self Retracting Lifelines Model

• Manufactured date

• Serial Number

• Lot Number

General Factors

• Impact Indicator - Inspect indicator for activation (rupture of red stitching, elongated indicator, etc.)

  Compliant

  Non-Compliant

  N/A

• Screws / Fasteners - Inspect for damage and make certain all screws and fasteners are tight.

  Compliant

  Non-Compliant

  N/A

• Housing - Inspect for distortion, cracks and other damage. Inspect anchoring loop for distortion and damage.

  Compliant

  Non-Compliant

  N/A

• Lifeline - Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, and discoloration, broken wires (see impact indicator section)

  Compliant

  Non-Compliant

  N/A

• Locking action - Inspect proper lock up of brake mechanism

  Compliant

  Non-Compliant

  N/A

• Retraction / Extension - Inspect spring tension by pulling lifeline out fully and allowing it to retract fully (no slack)

  Compliant

  Non-Compliant

  N/A

• Hooks / Carabiners - Inspect for physical damage, corrosion, proper operation and markings (see separate checklist/log for hooks and carabiners)

  Compliant

  Non-Compliant

  N/A

• Reserve Lifeline - Inspect reserve lifeline retention systems for deployment

  Compliant

  Non-Compliant

  N/A

• Labels - Inspect, make certain all labels are securely help and legible

  Compliant

  Non-Compliant

  N/A

• Overall Disposition:

  Pass

  Fail

  N/A

Signature

• Inspected by:

  Sign