Harness Inspection
Work Site
*
24060 8th on 8th
24099 Canalta
24143 Charleston Phase 2
25025 BPL Alpine Apartments
25054 Mary's Popcorn
25077 Baymag Staff Training
25085 TOC Utility Facilities
25125 Outside Bike
25132 Mountain Animal Hospital
If not listed above type job site here
Name of Inspector
*
First Name
Last Name
Date of Inspection
*
-
Month
-
Day
Year
Date
Harness Part/Serial #
Serial #
Date of First Use
-
Month
-
Day
Year
Date
Date of Manufacture
-
Month
-
Day
Year
Date
Harness Configuration
Chest Strap
Pass-Through
Tongue Buckle
Quick-Connect
Leg Straps
Pass-Through
Tongue Buckle
Quick-Connect
Waist Belt
Yes
No
LABELS AND MARKINGS
*
Rows
Pass or Fail
Notes
Label (Intact & Legible)
Pass
Fail
Appropriate ANSI/OSHA/CSA Markings
Pass
Fail
Inspections are Current / Up-to-Date
Pass
Fail
Date of First Use
Pass
Fail
Impact Indicator (Signs of Deployment)
Pass
Fail
HARDWARE (Buckles & D-Rings)
*
Rows
Pass or Fail
Notes
Shoulder Adjustment Buckles
Pass
Fail
Leg & Waist Buckles / Other Hardware
Pass
Fail
D-Rings (Dorsal, Side, Shoulder, or Sternal)
Pass
Fail
Corrosion / Pitting / Nicks
Pass
Fail
WEBBING
*
Rows
Pass or Fail
Notes
Shoulder / Chest / Leg / Back Straps
Pass
Fail
Cuts / Burns / Holes
Pass
Fail
Paint Contamination
Pass
Fail
Excessive Wear
Pass
Fail
Heat / UV Damage
Pass
Fail
STITCHING
Rows
Pass or Fail
Notes
Shoulder / Chest / Leg / Back Straps
Pass
Fail
Are you protected by guard rails?
*
Yes
No
Has a Fall Protection Plan been completed for this particular work already?
*
Yes
No
Inspector's Signature
*
Submit
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