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TCP CONSULTANTS PTE LTD

Fall Prevention Equipment Checklist

Full Body Harnesses

Harness Model: HT08 Manufacture Date: 09/2023

Serial Number: 047990/2023 Lot Number: Purchase Date: 11/12/2023

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1. Hardware: (Includes D-rings, buckles,
keepers, and back pads) Inspect for dam- ACCEPTED
age, distortion, sharp edges, burrs, cracks
and corrosion. REJECTED
2. Webbing: Inspect for cuts, burns, tears, ACCEPTED
abrasion, frays, excessive soiling and
dis-coloration. REJECTED

3. Stitching: Inspect for pulled or cutstitches. ACCEPTED

REJECTED

4. Labels: Inspect, make certain all labels are ACCEPTED

securely held in place and legible.
REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Lanyards
Lanyard Model: HT09 Manufacture Date: 09/2023

Serial Number: 000015/2023 Lot Number: Purchase Date: 11/12/2023

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1. Hardware: (Includes snap hooks,
carabiners, adjusters, keepers, thimbles ACCEPTED
and D-rings). Inspect for damage,
distortion, sharp edges, burrs, cracks, REJECTED
corrosion and proper operation.
2. Webbing: Inspect for cuts, burns, tears, ACCEPTED
abrasion, frays, excessive soiling and
discoloration. REJECTED

3. Stitching: Inspect for pulled or cutstitches. ACCEPTED

REJECTED

4. Synthetic Rope: Inspect for pulled or cut ACCEPTED

yarns, burns, abrasion, knots, excessive
soiling and discoloration. REJECTED

5. Wire Rope: Inspect for broken wires, ACCEPTED

corrosion, kinks and separation of strands.
REJECTED

6. Energy Absorbing Component: Inspectfor ACCEPTED

elongation, tears and excessive soiling.
REJECTED

7. Labels: Inspect, make certain all labels are ACCEPTED

securely held in place and legible.
REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Energy Absorber
Tie-Off Adaptor Model: HT 02K Manufacture Date: 09/2023

Serial Number: 048687/2023 Lot Number: Purchase Date: 11/12/2023

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1. Hardware: (Includes D-rings) Inspect for ACCEPTED
damage, distortion, sharp edges, burrs,
cracks and corrosion. REJECTED

2. Webbing: Inspect for cuts, burns, tears, ACCEPTED

abrasion, frays, excessive soiling and
discoloration. REJECTED

3. Stitching: Inspect for pulled or cutstitches. ACCEPTED

REJECTED

4. Labels: Inspect, make certain all labels are ACCEPTED

securely held in place and legible.
REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Hooks/Carabiners
Hook/Carabiner Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1. Physical Damage: Inspect for cracks, ACCEPTED
sharp edges, burrs, deformities and locking
operation.
REJECTED

2. Excessive Corrosion: Inspect for ACCEPTED

corrosion which effects the operation
and/or strength. REJECTED

3. Markings: Inspect, make sure certain ACCEPTED

marking(s) are legible.
REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Anchorage Plates
Anchorage Plate Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1. Physical Damage: Inspect for cracks, ACCEPTED
sharp edges, burrs, deformities and locking
operation. REJECTED

2. Excessive Corrosion: Inspect for ACCEPTED

corrosion which effects the operation
and/or strength. REJECTED

3. Fasteners: Inspect for corrosion, tightness, ACCEPTED

damage and distortion. If welded, inspect
weld for corrosion, cracks and damage. REJECTED

4. Markings: Inspect, make sure certain ACCEPTED

marking(s) are legible.
REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED

REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Self Retracting Lifelines
Anchorage Plate Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1. Impact Indicator: Inspect indicator for ACCEPTED
activation (rupture of red stitching, elon-
gated indicator, etc.) REJECTED

2. Screws/Fasteners: Inspect for damage ACCEPTED

and make certain all screws and
fastenersare tight. REJECTED

3. Housing: Inspect for distortion, cracks and ACCEPTED

other damage. Inspect anchoring loop for
distortion and damage. REJECTED

4. Lifeline: Inspect for cuts, burns, tears,

ACCEPTED
abrasion, frays, excessive soiling and
discoloration, broken wires (see impact
REJECTED
indicator section).
5. Locking Action: Inspect for proper lock-up ACCEPTED
of brake mechanism.
REJECTED

6. Retraction/Extension: Inspect spring ACCEPTED

tension by pulling lifeline out fully and
allowing it to retract fully (no slack). REJECTED

7. Hooks/Carabiners: Inspect for physical

ACCEPTED
damage, corrosion, proper operation and
markings (see separate checklist/log for
REJECTED
hooks and carabiners).
8. Reserve Lifeline: Inspect reserve lifeline ACCEPTED
retention systems for deployment.
REJECTED

9. Labels: Inspect, make certain all labels are ACCEPTED

securely held in place and legible.
REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Inspection Checklist/Log
Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1.
ACCEPTED

REJECTED

2. ACCEPTED

REJECTED

3. ACCEPTED

REJECTED

4. ACCEPTED

REJECTED

5. ACCEPTED

REJECTED

6. ACCEPTED

REJECTED

7. ACCEPTED

REJECTED

ACCEPTED INSPECTED BY:

Overall Disposition
REJECTED DATE INSPECTED:
Inspection Checklist/Log
Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

GENERAL FACTORS ACCEPTED/ SUPPORTIVE DETAILS OR COMMENTS

REJECTED
1.

2.

3.

4.

5.

6.

7.

INSPECTED BY:
Overall Disposition
DATE INSPECTED:
Fall Protection Equipment Inspection Log Classification Company

SERIAL # DATE MODEL # DESCRIPTION INSPECTION PASS FAIL INSPECTED INSPECTION PASS FAIL INSPECTED INSPECTION PASS FAIL INSPECTED COMMENTS
OF MFG. DATE BY DATE BY DATE BY

Green: Pass, Safe for Use Red: Remove from Service - Send to Manufacturer for Inspection/Servicing Black: Destroy Immediately