Title Page
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Conducted on
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Inspector
HARNESS INSPECTION
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Provide notes for any "Fail" or "At Risk" answer. Also provide notes for any item which should be monitored.
HARNESS REFERENCE INFO
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Identification Number (i.e. serial, part, etc.)
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Date / Year of First Use
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Date of Manufacture
LABELS AND MARKINGS (See 1)
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Labels are intact and legible
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Appropriate ANSI / OSHA Markings
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Impact Indicator (Signs of Deployment)
HARDWARE (BUCKLES & D-RINGS)
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Shoulder Adjustment Buckles (See 2)
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Leg & Waist Buckles / Other Hardware (See 3)
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D-Rings / Attachment Points (See 4)
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Corrosion / Pitting / Cracks / Nicks
MATERIAL (WEBBING)
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Straps: Shoulder / Chest / Leg / Back
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Stitching: Broken / Loose / Frayed / Missing
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Excessive Wear
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Cuts / Burns / Holes
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Chemical Exposure
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Heat / UV Damage
LANYARD INSPECTION
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Provide notes for any "Fail" or "At Risk" answer. Also provide notes for any item which should be monitored.
LANYARD REFERENCE INFO
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Identification Number (i.e. serial, part, etc.)
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Date / Year of First Use
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Date of Manufacture
LABELS AND MARKINGS (See 1)
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Labels are intact and legible
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Appropriate ANSI / OSHA Markings
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No Signs of Deployment
CONNECTORS (See 2)
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Connector (Self-Closing & Locking)
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Hook Gate / Mechanisms Operate Freely
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Corrosion / Pitting / Cracks / Nicks
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Compatible Harness / Lanyard Connection
MATERIAL (WEBBING) - See 3
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Stitching: Broken / Loose / Frayed / Missing
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Termination (Stitch / Splice)
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Lanyard Webbing Length
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Excessive Wear or Damage
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Cuts / Burns / Holes
SHOCK PACK (If Present) - See 4
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Cover / Shrink Tube (DO NOT REMOVE)
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Damage / Fraying / Broken Stitching
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No Signs of Deployment
WOOD POLE FALL RESTRICT DEVICE & SECONDARY LANYARD
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Provide notes for any "Fail" or "At Risk" answer. Also provide notes for any item which should be monitored.
WPFRD REFERENCE INFO
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Identification Number (i.e. serial, part, etc.)
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Date / Year of First Use
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Date of Manufacture
SECONDARY LANYARD REFERENCE INFO
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Identification Number (i.e. serial, part, etc.)
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Date / Year of First Use
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Date of Manufacture
CONNECTORS
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Locking Carabiners / Snaphooks (See 1)
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Latch Movement / Spring Tension
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Moving Pieces Operate Freely
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Web Grabs / Cam Buckles (See 2)
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Burns / Cracks / Deformation / Corrosion
HARDWARE
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Rivets not Loose or Bent
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Bolts not Loose or Bent
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D-Rings / Pass-Thru Devices (See 3)
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General Cracks / Deformation / Corrosion
MATERIAL (WEBBING & ROPE)
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Outer Strap / Rope (See 4)
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Inner Strap / Rope (See 5)
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Fold-Over / Splices (See 6)
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Excessive Wear (Indicator)
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Abrasions / Cuts / Frays
STITCHING (See 7)
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Stitching: Broken / Loose / Frayed / Missing
BODY BELT & CLIMBERS
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Provide notes for any "Fail" or "At Risk" answer. Also provide notes for any item which should be monitored.
BODY BELT REFERENCE INFO
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Identification Number (i.e. serial, part, etc.)
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Date / Year of First Use
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Date of Manufacture
CLIMBERS REFERENCE INFO
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Identification Number (i.e. serial, part, etc.)
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Date / Year of First Use
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Date of Manufacture
CLIMBING BELT (MATERIAL)
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Abrasion / Fraying / Cracking / Cuts / Wear
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Electrical Arc-Flash / Chemical Exposure
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Stitching: Loose / Cut / Broken / Frayed (See 1)
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Holes on Straps: Not Elongated or Modified (See 2)
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Tool Loops / Rings Securely Attached (See 3)
HARDWARE (BELT AND CLIMBERS)
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Cracks / Nicks / Distorted / Bent
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Electrical Arc-Flash Burns / Rust / Corrosion
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Rivets / Attachment Points (See 4)
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General Cracks / Deformation / Corrosion
CLIMBERS (STRAPS AND PADS)
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Abrasion / Fraying / Cracking / Cuts / Wear
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Electrical Arc-Flash / Chemical Exposure
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Stitching: Loose / Cut / Broken / Frayed (See 5)
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Holes on Straps: Not Elongated or Modified
CLIMBERS (SHANKS / GAFFS)
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Gaffs Properly Sharpened (Gaff Gauge Test)
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Effective Gaff Guards in Place
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Cracks / Deformed / Marks / Gouges
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Stirrup: Wear / Proper Adjustment
COMPLETION
INSPECTOR NAME AND SIGNATURE
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