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1 Full Body Harness Harness Model: General Factors / Supportive Details or Comments 1.) Hardware: (includes D-rings, buckles, keepers, and back pads) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion. 2.) Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, and discoloration. 3.) Stitching: Inspect for pulled or cut stitches. 4.) Labels: Inspect, make certain all labels are securely held in place and legible. 5.) 6.)

2 Lanyards Lanyard Model: General Factors / Supportive Details or Comments 1.) Hardware: (includes snap hooks, carabiners, adjusters, keepers, thimbles, and D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, corrosion and proper operation. 2.) Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, and discoloration. 3.) Stitching: Inspect for pulled or cut stitches. 4.) Synthetic Rope: Inspect for pulled or cut yarns, burns, abrasion, knots, excessive soiling and discoloration. 5.) Wire Rope: Inspect for broken wires, corrosion, kinks, and separation of strands. 6.) Energy Absorbing Component: Inspect for elongation, tears, and excessive soiling. Labels: Inspect, make certain all labels are securely held in place and legible.

3 Hooks / Carabiners Hook / Carabiner Model: General Factors / Supportive Details or Comments 1.) Physical Damage: Inspect for cracks, sharp edges, burrs, deformities and locking operation. 2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength. 3.) Markings: Inspect, make certain marking(s) are legible. 4.) 5.) 6.)

4 Tie-Off Adaptors Tie-Off Adaptor Model: General Factors / Supportive Details or Comments 1.) Hardware: (includes D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, and corrosion. 2.) Webbing: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling, and discoloration. 3.) Stitching: Inspect for pulled or cut stitches. 4.) Labels: Inspect, make certain all labels are securely held in place and legible. 5.) 6.)

5 Anchorage Plates Anchorage Plate Model: General Factors / Supportive Details or Comments 1.) Physical Damage: Inspect for cracks, sharp edges, burrs, and deformities. 2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength. 3.) Fasteners: Inspect for corrosion, tightness damage, and distortion. If welded, inspect weld for corrosion, cracks, and damage. 4.) Markings: Inspect, make certain marking(s) are legible. 5.) 6.)

6 Self Retracting Lifelines Self Retracting Lifeline Model: Owner/Dept./Location: Owner's I.D. no.: General Factors / Supportive Details or Comments 1.) Impact Indicator: Inspect indicator for activation (rupture of red stitching, elongated indicator, etc.). 2.) Screws / Fasteners: Inspect for damage and make certain all screws and fasteners are tight. 3.) Housing: Inspect for distortion, cracks, and other damage. Inspect anchoring loop for distortion and damage. 4.) Lifeline: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration, broken wires (see impact indicator section). 5.) Locking Action: Inspect for proper lock-up of brake mechanism. 6.) Retraction / Extension: Inspect spring tension by pulling lifeline out fully and allowing to retract fully (lifeline must be taut, no slack). Hooks / Carabiners: Inspect for physical damage, corrosion, proper operation, and markings (see separate checklist/log for hooks/carabiners). 8.) Reserve Lifeline: Inspect reserve lifeline retention system for deployment. 9.) Labels: Inspect, make certain all labels are securely held in place and legible.

7 Winch / Tripod / Davit Arm Model: General Factors / Supportive Details or Comments 1.) Winch: Inspect cable assembly, snap hooks, counter weight. Check for cuts, damage, broken wires, etc. 2.) Winch: Inspect ratchet brake, handle brake and drum brake, for operation, inspect teeth of drum for wear. 3.) Winch: Inspect housing for damage, check oil level, inspect mounting bracket (pin operation), and inspect fasteners. 4.) Winch: Inspect handle operation on low and high speed shaft. Check raising and lowering operations. 5.) Tripod: Inspect all bolts/nuts, check leg locking action, inspect leg chains, adjustable legs, pins and heads. 6.) Davit Arm: Inspect all bolts, nuts and pins, inspect tubing/pulleys for damage, and inspect base.

8 Rescue Positioning Device RPD Model: General Factors / Supportive Details or Comments 1.) Housing: Inspect for cracks, sharp edges, burrs, and deformities. Check anchorage loop for damage. 2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strengths. 3.) Fasteners: Inspect for corrosion, tightness, damage, and distortion. 4.) Rope: Inspect for cuts, burns, abrasion, frays, excessive soiling. Inspect end terminations. 5.) Pulleys: Inspect for cracks or distortion. 6.) Accessories: Inspect sling, rescue harness, carabiners, and storage bag. Markings: Inspect, make certain marking(s) are legible.

9 Rescumatic (SD100) SD100 Model: x (length) General Factors / Supportive Details or Comments 1.) Cover: Inspect for cracks, dents, and deformities. 2.) Rope: Inspect for wear, cuts, burns, soiling. Inspect end terminations. 3.) Fasteners: Inspect for corrosion, tightness, damage, and distortion. 4.) Mechanical Components: Inspect gears, brake shoes, brake drum for wear, corrosion, and damage. 5.) Frame: Inspect for corrosion, wear or damage. 6.) Accessories: Inspect carabiners, rescue slings, and storage bag. Markings: Inspect, make certain marking(s) are legible.

10 Model: 1.) General Factors / Supportive Details or Comments 2.) 3.) 4.) 5.) 6.)

11 This document was created with Win2PDF available at The unregistered version of Win2PDF is for evaluation or non-commercial use only.

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