V. Equipment Record
PART NUMBER
SERIAL NUMBER
DATE
MANUFACTURED
Werner Co. Self-Retracting Lifeline
Certifi ed to meet ANSI Z359 standards (see appendix for details)
and OSHA 29 CFR 1910 and 1926 for the Self-Retracting Lifeline
component of a complete personal fall arrest system.
Model, serial numbers, location and date of manufacture are on
product label.
VI. Inspection Record
DATE
INSPECTOR
Page 12
PURCHASE DATE
ASSIGNED TO
SPECIFICATIONS
RECORD
INSPECTION
PASS/FAIL
DATE
INSPECTOR
PASS/FAIL