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Harness Inspection Form
Manufacturer:
*
Owner/Company:
*
Model:
*
Description:
Serial:
*
Lot:
*
Date of Manufacture:
*
Harness Configuration:
Chest Strap:
PT
TB
Leg Straps:
PT
TB
Waist Belt:
Yes
No
Labels & markings
Label (Intact & Legible)
Pass
Fail
N/A
Appropriate ANSI/OSHA/CSA Markings
Pass
Fail
N/A
Inspections are Current / Up-to-Date
Pass
Fail
N/A
Date of First Use
Pass
Fail
N/A
Impact Indicator (Signs of Deployment)
Pass
Fail
N/A
HARDWARE (BUCKLES & D-RINGS)
Shoulder Adjustment Buckles
Pass
Fail
N/A
Leg & Waist Buckles / Other Hardware
Pass
Fail
N/A
D-Rings (Dorsal, Side, Shoulder, or Sternal)
Pass
Fail
N/A
Corrosion / Pitting / Nicks
Pass
Fail
N/A
Material (rope or Cable)
Broken / Missing / Loose Stitching
Pass
Fail
N/A
Shoulder / Chest / Leg / Back Straps
Pass
Fail
N/A
Cuts / Burns / Holes
Pass
Fail
N/A
Paint Contamination
Pass
Fail
N/A
Excessive Wear
Pass
Fail
N/A
Heat / UV Damage
Pass
Fail
N/A
Stitching
Shoulder / Chest / Leg / Back Straps
Pass
Fail
N/A
Notes:
Foreman Name:
Project Name:
Name of Inspector:
*
Date of Inspection:
*
Employee ID:
*
In-Service Date:
Print Name:
*
Signature:
*
Clear Signature
Upload Files :
Foreman Email:
Other Email:
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