Harness Inspection
Work Site
*
Max--Montana
Max--Princeton Cityscapes
Max--Rosewood Estates
Max--Stratford on the Park
Max --Riverview Place
Max --Riveside Towers
YCH-345-1-Doherty Residence
YCH-370-5-McCollister
YCH-183-31-8th Floor Demising Wall
YGC-374-15-Montana Gym
YGC-397-1-Canco Gas Station - Car Wash
YGC-402-1-134 Forge Rd SE Calgary
YGC-452-1-Master Bedroom Renovation
YGC--Southcenter Mall
Other
Other Jobsite
Name of Inspector
*
First Name
Last Name
Date of Inspection
*
-
Month
-
Day
Year
Date
Harness Part #
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 guardrails?
*
Yes
No
Has a Fall Protection Plan been completed for this particular work already?
*
Yes
No
Inspector's Signature
*
Submit
Should be Empty: