WORKING AT HEIGHTS

OHS-PR-09-15-F03(A) MONTHLY SAFETY HARNESS INSPECTION

Operating Area: Department:

Project Name:
Contractor Name: Project Type: Contract No.:

INSPECTOR NAME: YEAR:

Notes:
Do not “tick”. Write Ok or use the code of the specific deviation in the legend. If the Equipment is defective, it must be tagged “Defective”
and must be reported to the person responsible for the repair of the equipment. If the equipment is beyond repair it must be destroyed and
discarded. New equipment to replace the discarded equipment must be obtained to discourage the use of make shift equipment.

LEGEND: OK – ALL IN GOOD CONDITION, ELM– EQUIPMENT LOST OF MISSING, REP – EQIPMENT BEING REPAIRED, C – COMMENTS
H1 Unsafe and deteriorated lanyard H9 Damaged or deteriorating synthetic rope
H2 Damaged D-ring H10 Damaged or used shock absorber
H3 Damaged snap hook H11 Damaged or deteriorating shock absorbing lanyard
H4 Substandard Snap Hook H12 Elongation of the shock absorbing lanyard
H5 Damaged / corroded back pads H13 Torn or faded SWL labels
H6 Damaged Webbing H14 Expired Full Body Harness according to label
H7 Deteriorated / discoloured webbing H15 Unsafe repair / modification of full body harness
H8 Cut or wearing of stitching H16 Substandard Body Harness (not correct specification)

HARNESS
LOCATION / TYPE JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC
NO.

DATE OF INSPECTION:

INSPECTOR'S SIGNATURE:

SPOT-CHECK / AUDIT:
(Date and initials)

OHS Forms  Procedure Reference Revision Number Revision Date Approved By

MONTHLY SAFETY HARNESS INSPECTION OHS-PR-09-15-F03(A) 0 MAY 2021 OHSMS