Harness Inspection
Worker Name
*
Alec Demster
Astrit Martinaj
Ayden Bremner
Ben Peirce
Bernie Clapperton
Christian Wells
Conner Schulhof
Dean
Dirk Risse
Eamonn Walsh
Gary Kennelly
Janos Locz
Joel Edrosolano
Jordan Bergevin
Marko B
Mikey B
Oleksandr Skoropad
Ray Carriere
Roger
Stephen King
Trevor Jones
Willem Kamphorst
Other
Worker Email
*
example@example.com
Date of Inspection
*
-
Month
-
Day
Year
Date
Work Site
*
ALAIR - 209 Glen Banff
Ashton - 8th and 8th
Ashton - CCH Stewart Creek
Ashton - Meadows
Ashton - Trinity Bible Church
Barjac - Calgary Hyundai
Barjac - Country Hills Kia
Barjac - Wolfe
BECL
Bird - fire cache
Bird - Rundle Park
Bruce - Bow Lake Cabins
Cairo - Ascent
CHANDOS - Canmore Water Plant
Clark builders - Fernie
CRMR - Buffalo MTN Lodge
DMF SHOP
Highpoint - Cascade Canmore GP Ltd
Kalaimor - Brookside 10th Street
Kalaimor - MTN house
SBL - iPlace
SBL - settlers
Stuart Olson - Banff Center
TOB
TOC - Elevation Place
TRAILER AND OFFICE
If not listed above type job site here
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 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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