Title Page

  • Document No.

  • Conducted on

  • Prepared by

  • Location
  • 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.)

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

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

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

  • Locking action - Inspect proper lock up of brake mechanism

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

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

  • Reserve Lifeline - Inspect reserve lifeline retention systems for deployment

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

  • Overall Disposition:

Signature

  • Inspected by:

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