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

  • Diameter of Lifeline

  • Length of Lifeline

  • Material (Wire, Rope, etc.)

  • Name of Competent Inspector:

Hardware

  • Function of Connector Locking Gate

  • Body of Hook

  • Corrosion

  • Pitting

  • Nicks

  • Hardware Notes

Termination

  • Broken, Missing, or Loose Stitching

  • Termination (Stitch or splice or swage)

  • Termination Notes

Lifeline (Rope or Wire)

  • Cuts

  • Fraying

  • Excessive Wear

  • Impact Indicator

  • Kinks

  • Caging

  • Broken Strands or Fibers

  • Melting

  • Lifeline Notes

Shock Pack (if supplied)

  • Integrity of Cover

  • Signs of Deployment

  • Signs of Damage

  • Shock Pack 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.