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Idiomas disponibles
Idiomas disponibles
21.0 INSPECTION FORM
Product lifetime is indefinite as long as it passes pre-use and Competent Person inspections. User must inspect prior to
each use. Competent Person other than the user must complete formal inspection at least annually.
Manufacturer:
Model Number:
Description:
Serial Number:
Lot Number:
Date of Manufacture:
LABELS & MARKINGS
Label (Intact and Legible)
Appropriate ANSI / OSHA / CSA Markings
Inspections are Current / Up-to-Date
Date of First Use
Impact / Fall Indicators Not Deployed
HARDWARE
(Buckles & D-Rings)
Signs of Deformity of Damage
Proper D-ring attachment and operation
All Buckles Undamaged and Operational
Corrosion / Pitting / Nicks
Ensure Grommets are Secure / Do Not Move
WEBBING
Shoulder / Chest / Leg / Back Straps
Cuts / Burns / Holes
Paint Contamination
Excessive Wear
Heat / UV Damage
STITCHING
Shoulder / Chest / Leg / Back Straps
NOTES
225 Wilshire Avenue SW, Concord NC 28025
PASS
FAIL
NOTE
PASS
FAIL
NOTE
PASS
FAIL
NOTE
PASS
FAIL
NOTE
If equipment fails inspection
IMMEDIATELY REMOVE FROM SERVICE
V2.0 2022 Copyright Safewaze
INSPECTION FORM
Company:
Name of Inspector:
Signature:
Date of Inspection:
In-Service Date:
PT
Chest
Harness Configuration:
Strap
Dorsal
D-Ring
Labels
Back
Strap
Impact Indicators
•
800-230-0319
•
User Manual
HARNESSES
TB
PT
TB
Yes No
Leg
Waist
Straps
Belt
CONSTRUCTION HARNESS
Shoulder
Straps
Chest
Strap
Adjustment
Buckles
Side
D-Rings
Waist Belt
Leg Straps
FULL BODY HARNESS
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