Harness Inspection
Work Site
*
Work Site for PDF
Work Site (OLD)
24060 8th on 8th
24099 Canalta
24110 Beamers Gateway
25025 BPL Alpine Apartments
25132 Mountain Animal Hospital
26007 Charleston Phase 2
If not listed above type job site here
Name of Inspector
*
First Name
Last Name
Date of Inspection
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Harness Part/Serial #
Serial #
Date of First Use
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Manufacture
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit 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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