Tricounty Hard Hat Inspection Form

• 

• Conducted on

  Date

• Inspector

• Provide notes for any "Fail" or "At Risk" answer. Also provide notes for any item which should be monitored.

  

HARD HAT REFERENCE INFO

• Manufacturer

• Date / Year of First Use

SHELL (See 1)

• Cracks / Dents / Nicks / Gouges

  Safe

  At Risk

  N/A

• Stiff / Brittle

  Safe

  At Risk

  N/A

• Faded / Dull

  Safe

  At Risk

  N/A

• Flaky Surface / Chalky Appearance

  Safe

  At Risk

  N/A

• Other Damage or Wear

  Safe

  At Risk

  N/A

• Added-on Items Properly Attached

  Safe

  At Risk

  N/A

• STANDARD FIELD TEST: Compress the shell inward from the sides about 1 inch with both hands, then release the pressure without dropping the shell. The shell should quickly return to its original shape, exhibiting elasticity. There should be no residual deformation. Compare the elasticity of the sample with that of a new shell. If the sample does not exhibit elasticity similar to that of a new shell, or if it cracks because of brittleness, it should be replaced immediately.

• Field Test Passed

  Safe

  At Risk

  N/A

SUSPENSION

• Pliable / No Cracks (See 2)

  Safe

  At Risk

  N/A

• Frayed / Torn Crown Straps (See 3)

  Safe

  At Risk

  N/A

• Headband not Torn (See 4)

  Safe

  At Risk

  N/A

• Adjustment Functions Properly (See 5)

  Safe

  At Risk

  N/A

• Other Damage / Wear

  Safe

  At Risk

  N/A

SERVICE LIFE

• 1. Bullard minimum recommendation: replace suspension annually; replace shell every two (2) years when exposed to direct sunlight.
  2. MSA minimum recommendation: replace suspension annually; replace shell every five (5) years when exposed to direct sunlight.
  3. 3M minimum recommendation: replace suspension annually; replace shell every two (2) to five (5) years, depending on work environment.
  4. Pyramix minimum recommendation: replace suspension every one (1) to two (2) years; average service life of shell is six (6) months to two (2) years, depending upon application, but up to five (5) years after being placed into service. Shell should be replaced every two (2) years when exposed to direct sunlight. Immediate replacement should follow any direct hit.

• Shell

  Safe

  At Risk

  N/A

• Suspension

  Safe

  At Risk

  N/A

INSPECTOR NAME AND SIGNATURE

• Add signature

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