Self-Retracting Lifeline Inspection Form
This inspection is to be completed for Validus Energy owned SRLs
Inspector
First Name
Last Name
Date of Inspection
-
Month
-
Day
Year
Date
Feild Office
Manufacturer
Model
Serial Number
If the serial number cannot be read, the inspection Fails
Impact Indicator
Inspect indicator for activation. (rupture of red stitching, elongated indicator, etc).
Pass
Fail
Comments
Screws/Fasteners
Inspect for damage and make certain all screws and fasteners are tight.
Pass
Fail
Comments
Housing
Inspect for distortion, cracks and other damage. Inspect anchoring loop for distortion and damage.
Pass
Fail
Comments
Lifeline
Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration, broken wires (see impact indicator section).
Pass
Fail
Comments
Locking Action
Inspect for proper lockup of brake mechanism.
Pass
Fail
Comments
Retraction/Extension
Inspect spring tension by pulling lifeline out fully and allowing it to retract fully (no slack).
Pass
Fail
Comments
Hooks/Caribiners
Inspect for physical damage, corrosion, proper operation and markings.
Pass
Fail
Reserve Lifeline
Inspect reserve lifeline retention systems for deployment.
Pass
Fail
Labels
Inspect and make certain all labels are securely held in place and legible.
Pass
Fail
Comments
Inspection Result
All Components must pass for a passing result.
Pass
Fail
Comments
Submit
Should be Empty: