Title Page
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Inspectors Name
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Date
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Location
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Owner
Harness Inspection
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Make
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Model
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Image of harness
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Image of serial number
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Date of manufacturer
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Additional notes or description
Buckles
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Inspected
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Pass/fail
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Detail failure
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Photo of failure
Webbing
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Inspected
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Pass/fail
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Detail failure
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Photo of failure
Stitching
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Inspected
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Pass/fail
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Detail failure
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Photo of failure
Labels
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inspected
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Pass/fail
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Detail failure
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Photo of failure
Carabiner
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
Cows tail
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
Eye Bolts
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Image of item
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Additional notes
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Pass/Fail
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Detail failure
3m tie off
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
Ladder yoke
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
Cat tie off
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
Bag
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Image of item
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Additional notes
Rope grab
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
15m rope and scaffold hook
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
6m tie off
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
6m tie off
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Make
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Model
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Image of item
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Image of serial number
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Date of manufacture
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Additional notes
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Pass/Fail
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Detail failure
Confirmation of condition
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Kit is in a satisfactory condition to be used
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Detail reason for failure
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Detail re-check date
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inspectors Signature
