HARNESS / LANYARD INSPECTION FORM

Name of Inspector:_____________________ Week of:____________________ Signature_______________________

Harness Inspection Lanyard Inspection
Make: Make:
Model: Model:
Serial: Serial:
Date of Manufacture: Date of Manufacture:

LABELS & MARKINGS M T W T F S S LABELS & MARKINGS M T W T F S S

Label (Intact & Legible) Label (Intact & Legible)
Appropriate ANSI/OSHA/CSA Markings Appropriate ANSI/OSHA/CSA Markings
Inspection are Current/Up-to-Date Inspection are Current/Up-to-Date
Impact Indicator (Signs of Deployment)
HARDWARE (CONNECTORS)
HARDWARE (BUCKLES & D-RINGS) Function of Connector Locking Gate
Shoulder Adjustment Buckles Body of Hook & Rivets
Leg & Waist Buckles/Other Hardware Corrosion / Pitting / Nicks / Other Damage
D-Rings (Dorsal, Side, Shoulder or Sternal)
Corrosion / Pitting / Nicks WEBBING
Broken, Missing or Loose Stitching
WEBBING Cuts / Burns / Holes
Shoulder / Chest / Leg / Back Straps Chemical / Paint Contamination
Cuts / Burns / Holes Excessive Wear / Deterioration
Chemical / Paint Contamination Heat / UV Damage
Excessive Wear / Deterioration
Heat / UV Damage SHOCK PACK
Integrity of Cover
STITCHING Signs of Deployment
Shoulder / Chest / Leg / Back Straps Signs of Damage
Notes: Notes:

DEFECTIVE EQUIPMENT SHALL BE REMOVED FROM SERVICE & REPORTED TO YOUR SUPERVISOR IMMEDIATELY!