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:

  • Type of Lanyard

Hardware

  • Function of Connector Locking Gate

  • Body of Hook or Rivets

  • Corrosion

  • Pitting

  • Nicks

  • Hardware Notes

Webbing

  • Broken, Missing, or Loose Stitching

  • Termination (stitch or splice or swage)

  • Webbing Length

  • Deterioration

  • Cuts

  • Burns

  • Holes

  • Paint Damage

  • Webbing Notes

Shock Pack

  • 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.