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Fall Protection Inspection Form
Please fill the form below
1
Step 1
2
Step 2
Job Name:
This field is required.Please enter value
Operator:
This field is required.Please enter value
D-RING & BUCKLES:
N/A
Option 1
Option 2
Option 3
Are not broken, damaged or distorted in shape.
There is no corrosion, cracks, worn parts or sharp edges.
Works freely without effort.
Harness Webbing:
N/A
Option 1
Option 2
Option 3
Has no fraying or broken fibers.
There is no abrasion, tearing, burns, mold or discoloration of webbing.
There is no dirt, paint, or other residue buildup degrading webbing integrity.
There are no cuts, pulled, or broken stitches
Harness Labels and Warnings:
N/A
Option 1
Option 2
Option 3
Are securely fastened and are still legible?
Safety Tab:
N/A
Option 1
Option 2
Option 3
Concealed portion of safety tab has not been exposed.
Double- Locking Snap Hooks and Rebar Hooks:
N/A
Option 1
Option 2
Option 3
Are not broken, damaged or distorted in shape.
There is no corrosion, cracks, worn parts, or sharp edges.
Are in working order and close properly and securely.
Next
Lanyard Material:
N/A
Option 1
Option 2
Option 3
Has no fraying or broken fibers.
There is no abrasion, tearing, burns, mold, discoloration, or cuts.
There are no cuts, pulled or broken stitches.
Shock Absorber Component of Fall Arrest:
N/A
Option 1
Option 2
Option 3
Cover is not torn or broken.
Shock absorber has not been elongated more than six inches (15 cm)
Statement Three
Safety Tab:
N/A
Option 1
Option 2
Option 3
Concealed portion of safety tab has not been exposed
Operator Signature:
This field is required.Please enter value
Manager Signature:
This field is required.Please enter value
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