Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Fall Protection Equipment Information

  • Select type of equipment to be inspected:

  • Manufacturer

  • Model #:

  • Asset ID:

  • Serial Number:

  • Date of Manufacture

  • Date of First Use

  • Name of Competent Inspector:

Hardware

  • Signs of Deformity

  • Body of D-Ring

  • Corrosion

  • Pitting

  • Nicks

  • Bars, Shafts, Housing

  • Signs of Damage

  • Impact Indicators

  • Hardware Notes

Webbing

  • Termination to Connector

  • Deterioration

  • Melting

  • Cuts

  • Burns

  • Webbing Notes

Stitching/Cable

  • Signs of Damage

  • Kinks or Caging

  • Broken Strands or Fibers

  • Stitch/Cabling Notes

Labels/Tags

  • Appropriate ANSI/OSHA Markings (ANSI Z359/ANSI A10.32-12, OSHA 1910 & 1926 Subpart M)

  • Legible Label

  • Label/Tag Notes

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.