Woodruff Vertical Lifeline Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Fall Protection Equipment Information

• Select type of equipment to be inspected:

  Select Harness Lanyard Carabiner SRL Anchor Point Vertical Lifeline Horizontal Lifeline Rope Grab Other

  • Harness
  • Lanyard
  • Carabiner
  • SRL
  • Anchor Point
  • Vertical Lifeline
  • Horizontal Lifeline
  • Rope Grab
  • Other

• Manufacturer

• Model #:

• Asset ID:

• Serial Number:

• Date of Manufacture

• Date of First Use

• Diameter of Lifeline

• Length of Lifeline

• Type of Material

  Blue Poly Steel

  White Polydac

  Kernmantle

• Name of Competent Inspector:

Hardware

• Function of Connector Locking Gate

  Pass

  Fail

  N/A

• Body of Hook

  Pass

  Fail

  N/A

• Corrosion

  Pass

  Fail

  N/A

• Pitting

  Pass

  Fail

  N/A

• Nicks

  Pass

  Fail

  N/A

• Hardware Notes

Termination

• Broken, Missing, or Loose Stitching

  Pass

  Fail

  N/A

• Termination (Stitch or splice or swage)

  Pass

  Fail

  N/A

• Termination Notes

Lifeline (Rope or Wire)

• Cuts

  Pass

  Fail

  N/A

• Fraying

  Pass

  Fail

  N/A

• Excessive Wear

  Pass

  Fail

  N/A

• Impact Indicator

  Pass

  Fail

  N/A

• Kinks

  Pass

  Fail

  N/A

• Caging

  Pass

  Fail

  N/A

• Broken Strands or Fibers

  Pass

  Fail

  N/A

• Melting

  Pass

  Fail

  N/A

• Lifeline Notes

Shock Pack (if supplied)

• Integrity of Cover

  Pass

  Fail

  N/A

• Signs of Deployment

  Pass

  Fail

  N/A

• Signs of Damage

  Pass

  Fail

  N/A

• Shock Pack Notes

Labels/Tags

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

  Yes

  No

  N/A

• Legible Label

  Yes

  No

  N/A

• Label/Tag Notes