Fall Protection Inspection Form

Fall Protection Inspection Form

Veracity Field Services
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Job Supervisor (required)

First NameLast Name
Supervisor Email (required)
example@example.com
Inspected By

First NameLast Name
All parts of body harness and attachments are to be checked for excessive wear and damage. Body harness shall be visually inspected prior to each use.

Body Harness

Rows	Satisfactory	Not Satisfactory	Cause for Removal From Service
Harness Webbing
All Stitching
Rivets and Eyelets
D-rings & Buckle
Body Pad (if applicable)
Lanyard Carabineer
Fall Warning Tag Intact
No Cuts, Corrosion, Burning
Overall Condition

Fall Protection Systems

Rows	Satisfactory	Not Satisfactory	Cause for Removal From Service
Vertical Lifeline
Horizontal Lifeline
Warning Lines
Guard Rails
Retractable Lanyards
Hole Covers
Positioning Devices

Signature of Inspector
Should be Empty: