inspection checklist / log - diversified fall protection · inspection checklist / log harness...
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© 2014 Capital Safety 1-800-328-6146 Appendix 1: Inspection Checklist/Logs 51
APPENDIX 1: INSPECTION CHECKLIST/LOGS
Inspection Checklist / Log
Harness Model: _________________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) Hardware: (Includes D-rings, buckles, keepers and back pads) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) Stitching: Inspect for pulled or cut stitches. ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
4.) Labels: Inspect, make certain all labels are securely held in place and legible.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
DATE INSPECTED: ______________________________________
FULL BODY HARNESS
APPENDIX 1: INSPECTION CHECKLIST/LOGS
52 Appendix 1: Inspection Checklist/Logs 1-800-328-6146 © 2014 Capital Safety
Inspection Checklist / Log
Lanyard Model: _________________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) Hardware: (Includes snap hooks, carabiners, adjusters, keepers, thimbles and D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, corrosion and proper operation.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) Stitching: Inspect for pulled or cut stitches. ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
4.) Synthetic Rope: Inspect for pulled or cut yarns, burns, abrasion, knots, excessive soiling and discoloration.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
5.) Wire Rope: Inspect for broken wires, corrosion, kinks and separation of strands.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
6.) Energy Absorbing Component: Inspect for elongation, tears and excessive soiling.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
7.) Labels: Make certain all labels are securely held in place and legible.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
INSPECTED BY: ________________________________________
LANYARDS
© 2014 Capital Safety 1-800-328-6146 Appendix 1: Inspection Checklist/Logs 53
APPENDIX 1: INSPECTION CHECKLIST/LOGS
Inspection Checklist / Log
Tie-Off Adaptor Model: __________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) Hardware: (Includes D-rings) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) Stitching: Inspect for pulled or cut stitches. ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
4.) Labels: Inspect, make certain all labels are securely held in place and legible.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
DATE INSPECTED: ______________________________________
TIE-OFF ADAPTORS
APPENDIX 1: INSPECTION CHECKLIST/LOGS
54 Appendix 1: Inspection Checklist/Logs 1-800-328-6146 © 2014 Capital Safety
Inspection Checklist / Log
Hook / Carabiner Model: _________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) Physical Damage: Inspect for cracks, sharp edges, burrs, deformities and locking operation.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) Markings: Inspect, make sure certain marking(s) are legible.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
DATE INSPECTED: ______________________________________
HOOKS / CARABINERS
© 2014 Capital Safety 1-800-328-6146 Appendix 1: Inspection Checklist/Logs 55
APPENDIX 1: INSPECTION CHECKLIST/LOGS
Inspection Checklist / Log
Anchorage Plate Model: __________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) Physical Damage: Inspect for cracks, sharp edges, burrs and deformities.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) Fasteners: Inspect for corrosion, tightness, damage and distortion. If welded, inspect weld for corrosion, cracks and damage.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
4.) Markings: Inspect, make sure certain marking(s) are legible.
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
DATE INSPECTED: ______________________________________
ANCHORAGE PLATES
APPENDIX 1: INSPECTION CHECKLIST/LOGS
56 Appendix 1: Inspection Checklist/Logs 1-800-328-6146 © 2014 Capital Safety
Inspection Checklist / Log
Self Retracting Lifeline Model: _____________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Owner / Dept. / Location: __________________________________________________________________
Owner's ID #: ____________________________________________________________________________
Comments: ______________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) Impact Indicator: Inspect indicator for activation (rupture of red stitching, elongated indicator, etc.)
ACCEPTED REJECTED
_________________________________________________________________________________________________________
2.) Screws / Fasteners: Inspect for damage and make certain all screws and fasteners are tight.
ACCEPTED REJECTED
_________________________________________________________________________________________________________
3.) Housing: Inspect for distortion, cracks and other damage. Inspect anchoring loop for distortion and damage.
ACCEPTED REJECTED
_________________________________________________________________________________________________________
4.) Lifeline: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration, broken wires (see impact indicator section).
ACCEPTED REJECTED
_________________________________________________________________________________________________________
5.) Locking Action: Inspect for proper lock-up of brake mechanism.
ACCEPTED REJECTED
_________________________________________________________________________________________________________
6.) Retraction/Extension: Inspect spring tension by pulling lifeline out fully and allowing it to retract fully (no slack).
ACCEPTED REJECTED
_________________________________________________________________________________________________________
7.) Hooks / Carabiners: Inspect for physical damage, corrosion, proper operation and markings (see separate checklist/log for hooks and carabiners).
ACCEPTED REJECTED
____________________________________________________________________________________________________________________________________________
8.) Reserve Lifeline: Inspect reserve lifeline retention systems for deployment.
ACCEPTED REJECTED
_________________________________________________________________________________________________________
9.) Labels: Inspect, make certain all labels are securely held in place and legible.
ACCEPTED REJECTED
_________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED REJECTED
INSPECTED BY: ________________________________________DATE INSPECTED: ______________________________________
SELF RETRACTING LIFELINES
© 2014 Capital Safety 1-800-328-6146 Appendix 1: Inspection Checklist/Logs 57
APPENDIX 1: INSPECTION CHECKLIST/LOGS
________________ Model: ________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
4.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
5.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
6.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
7.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
DATE INSPECTED: ______________________________________
INSPECTION CHECKLIST / LOG
58 Appendix 1: Inspection Checklist/Logs 1-800-328-6146 © 2014 Capital Safety
APPENDIX 1: INSPECTION CHECKLIST/LOGS
________________ Model: ________________________________________ Manufacture Date: __________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
GENERAL FACTORS ACCEPTED / REJECTED SUPPORTIVE DETAILS OR COMMENTS
1.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
2.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
3.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
4.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
5.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
6.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
7.) ACCEPTED
REJECTED
____________________________________________________________________________________________________________________________________________
OVERALL DISPOSITION
ACCEPTED
REJECTED
INSPECTED BY: ________________________________________
DATE INSPECTED: ______________________________________
INSPECTION CHECKLIST / LOG
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