QO9.d.. e v -.PXresat

Similar documents
City of New London. Fall Protection. Program

Suffolk County Community College. Fall Protection Program. April 2014

Marquette University Fall Protection Program

ILLINOIS INSTITUTE OF TECHNOLOGY SAFETY POLICY COMMITTEE. Fall Protection Program

Fall Protection. Fall Speed vs. Reaction Time. Good body reaction time = 0.5 seconds Travel distance in 0.5 seconds = 4 feet (1.21mts.

Fall Speed vs. Reaction Time

New Mexico Institute of Mining & Technology. Fall Protection Program

DREW UNIVERSITY FALL PROTECTION PROCEDURE (DRAFT 12/11)

Doc No: FPP CARDINAL SURVEYS COMPANY. Safety Management System. Initial Revision Date: Version Revision No. 02 FALL PROTECTION

Fall Protection STANDARD PROCEDURE INSTRUCTION. Fall Protection. Title SPI. Department. Supersedes SPI Dated. Jan 19, 2016.

Fall Protection Program

Progressive Safety Services LLC

FALL PROTECTION SAFETY PROGRAM

Fall Protection Checklist. Guardrail System

ARKANSAS TECH UNIVERSITY FACILITIES MANAGMENT HEALTH AND SAFETY MANUAL

TAMPA ELECTRIC COMPANY ENERGY SUPPLY FALL PROTECTION PROGRAM

FACILITIES MANAGEMENT OFFICE OF ENVIRONMENTAL HEALTH AND SAFETY Fall Protection Policy 11/21/14 Last Revision

8. Fall Protection Procedures WAC

Serial Number: Lot Number: Purchase Date: General Factors Accepted / Rejected Supportive Details or Comments. Accepted Rejected.

Safety Tips from the WorkSafe People

You may order this publication from WCB Publications and Videos, Please quote ordering number BK60.

Section 16B. Fall Protection. Falls are the second leading cause of death in the workplace. Factors contributing to falling incidents:

1 of 15. Policy Number 61. Last Update: March 21, Effective Date: 11/22/11 Resolution No Title: Fall Protection Policy POLICY STATEMENT

??????? is committed to providing a safe work environment for its employees and preventing occupational injuries due to falls.

workplace fatalities involving falls to a lower level. Fall related fatalities make up 16% of workplace fatalities

Fall Protection ABC s

UNIVERSITY OF MINNESOTA University Health and Safety FALL PROTECTION PROGRAM

FALL PROTECTION PROGRAM (OHS-0010)

Fall Protection Refresher Orientation. Fall Protection Refresher Orientation 1

FALL PROTECTION PROGRAM

Written Program. For. Fall Protection. <<Company Name>> <<911 Address>> <<City, state, zip code>>

Title: Fall Protection Policy. University Division/Department: Environmental Health & Safety Effective Date : Revised:

1.0 Scope and Application

Fall Protection. Fall Protection

Dutchess Community College. Fall Protection Program

A. Employer Provide fall protection to effected employees Ensure that all employees understand and adhere to the procedures of this plan

At the end of this presentation you should know the difference between fall prevention, fall restraint, and fall arrest.

Step By Step How to Establish, Manage and Implement a Fall Protection Program

29 CFR 1926, Subpart M. Fall Protection Program Table of Contents

Fall Protection 4/7/16

Walking-Working Surfaces Fall Protection Program

Product Name: Edge Series Web SRL

WARNING! DO NOT THROW AWAY THESE INSTRUCTIONS! READ AND UNDERSTAND BEFORE USING EQUIPMENT!

GEMTOR. ... when your life is on the line OWNER'S MANUAL. FLW Series Self-Retracting Lanyard/Fall Limiter

11.4 FALL-ARREST SYSTEM AND EQUIPMENT CHECKLIST (Must answer yes to all applicable questions)

Fall Protection Introduction

OPE Training Seminar Agenda

Product Name: Hold Me Rope Anchor

FALL PROTECTION PLAN July 2012

Product Name: Internal Shock Lanyard

Product Name: Concrete Anchor Strap

FALL PROTECTION PLAN

Safety Manual Page 1 of 15

2.2. Anchorage Point A secure point of attachment for Lifelines, lanyards or deceleration devices.

User Instructions 1790 Rail Anchor

VERSION 1.0 FEBRUARY 1, 2017 FALL PROTECTION AND ELEVATED WORK UNC CHARLOTTE 9201 UNIVERSITY CITY BLVD., CHARLOTTE, NC 28223

This training session provides important information on fall protection at construction sites. Anyone who is exposed to potential fall hazards must

Fall Protection Training

PFI Fall Protection Best Practice

Inspection & Maintenance

Part #: 42000; 42001; 42002; 42003; 42004; 42005; 42006; 42008

Reviewed: New Effective: 5/18/12 Supersedes: New Preparer: Owner: Approver: Team Member, Occupational Safety Industrial Hygiene

FALL PROTECTION COMPARISON BETWEEN VARIOUS OSHA STANDARDS, NAVY and EM 385 (2008) REQUIREMENTS

WARNING! DO NOT THROW AWAY THESE INSTRUCTIONS! READ AND UNDERSTAND BEFORE USING EQUIPMENT!

Product Name: Rope Grab

Risk Control at United Fire Group

USER S INSTRUCTION MANUAL FOR THE INSTALLATION, OPERATION & MAINTENANCE OF THE GUARDIAN TEMPORARY HORIZONTAL LIFELINE SYSTEM

SAFETY DIRECTIVE 2.0 DEPARTMENTS AFFECTED. This Administrative Directive shall apply to all Town of Marana departments and employees.

fall arrest. Contact your distributor or Guardian about policies regarding replacement of Guardian components involved in a fall.

1.2 LIMITATIONS: Consider the following application limitations before using this equipment:

FALL PROTECTION (SAF-SPI-06)

Product Name: Edge Angel SRL

FALL PROTECTION WORK PLAN (Alstom Power Installation Canada)

INSTRUCTIONS FOR USE

IMPORTANT: If you have questions on the use, care, application, or suitability of this equipment contact DBI/SALA.

To remind workers that falling from heights can result in serious injury. Enter your name and the training date on the Training Sign-In Sheet.

RIGGERS SAFETY SAFETY IS IN THE DETAILS FULL LINE CATALOG

Fall Protection PPE Inspection

Product Name: Non-Shock Lanyard

Fall Protection and Elevated Work

Subchapter 4. Construction Safety Orders Article 24. Fall Protection. Return to index New query

FALL PROTECTION CODE OF PRACTICE

Villanova University Department of Environmental Health and Safety Policy and Procedure Manual. Table of Contents. I. Purpose and Scope 3. II.

Self Retracting Device User Instruction Manual

RIGGERS SAFETY SAFETY IS IN THE DETAILS FULL LINE CATALOG

Doc #: 1000-AD Revision: - FALL PROTECTION PLAN SOP. Author(s): T. Lavoie/ M. Saucedo/ J. Dunlop/ Mtn. Supervisor

FREQUENTLY ASKED QUESTIONS ABOUT FALL PROTECTION

1 of 9 12/30/15, 3:44 PM

Product Name: Angel Anchor

Health, Safety, Security and Environment

Fall Protection- Part 2

The purpose of this training is to give field technicians awareness training and guidelines on potential hazards they may encounter in the field.

CHAPTER 10 FALL PROTECTION

Effective Date: 10-January Table of Contents

INSTRUCTIONS FOR USE

IMPORTANT: Record the product identification information from the ID label in the inspection and maintenance log in section 9.0 of this manual.

FALL PROTECTION / ELEVATED WORK

What is fall protection?

Fall Hazards, Anchor Points and Fall Clearances OSH-2 August 7, 0900

Module Overview Module Description Not a substitute for standards. Training should not be considered as substitute for safety and health standards for

Transcription:

BEFORE THE BOARD OF COUNTY COMMISSIONERS, COWLITZ COUNTY, WA. In the Matter of Rescinding Res. No. 93-037 Adopted 3-8 -1993 and Adopting The Updated Fall Protection Policy RESOLUTION NO. 3 n 2 WHEREAS, the Board of Commissioners of Cowlitz County, Washington recognizes the need to establish a policy relating to Fall Protection; and WHEREAS, Cowlitz County recognizes that its employees are the most important assets involved in meeting the service needs of its citizens; and WHEREAS, the County also recognizes that safeguarding the health and welfare of its employees cannot be stressed too strongly; and WHEREAS, it is the policy of Cowlitz County that every reasonable effort will be made to provide and maintain a safe and healthy workplace and to establish and insist that its employees use safe methods and practices at all times. NOW, THEREFORE, BE IT HEREBY RESOLVED that the attached Fall Protection Policy be and is hereby adopted. IT IS HEREBY FURTHER RESOLVED that Resolution No. 93-037 dated March 8, 1993 is hereby rescinded. DATED: kocapja. ( 9, 2013. BOARD OF COUNTY COMMISSIONERS OF COWLITZ COUNT WASHINGTON Michael A. Karnofski Chair NINIII1. 4I isner, Co issioner ATTEST: QO9.d.. e v -.PXresat Dennis P. Weber, Commissioner Clerk of the Boar

COWLITZ COUNTY ISSUE DATE: March 2013 POLICY POLICY SOURCE: Cowlitz County Government Reviewed by Attorney's Office Date: TITLE FACILITY MAINTENANCE FALL LAST UPDATED: AUDIENCE: Cowlitz County Employees Contractors Risk Manger Approval Date: PROTECTION POLICY SECTION: Safety Policies TOTAL PAGES: 13 BOARD APPROVAL DATE: I. PURPOSE Establishment of guidelines to protect all employees engaged in work activities that expose them to potential falls from elevations. Compliance with WISHA guidelines. II. POLICY The County is committed to provide a safe workplace. Employees and contractors are expected to follow all rules and regulations related to this policy. Failure to comply with this policy may lead to disciplinary action up to and including termination. This program includes all Cowlitz County employees and contractors engaged in work activities that expose them to: falls from heights of six (6) feet or more when engaged in construction activities; falls from four (4) feet or more performing general activities, or falls of 10 feet or more from ladders. III. DEFINITIONS A. Anchor Point: A secure point of attachment for a lifeline, lanyards, or deceleration devices. An anchor point must be capable of supporting at least 5,000 pounds (3,600 pounds if engineered /certified by a qualified person) per person and must be independent of any anchorage being used to support or suspend platforms. B. Authorized Person: A person approved or assigned by the Director /Manager/ Supervisor to perform a specific type of duty or to be at a specific location or job site (e.g., building maintenance, roof repair,). C. Competent Person: A person capable of identifying existing and predictable hazards in the surroundings or working conditions that could be hazardous or dangerous to employees or contractors. A person who has the authorization to take prompt corrective action to eliminate such hazards. D. Connector: A device that is used to couple (connect) parts of the personal fall arrest system. E. Deceleration Device: Any mechanism, including but not limited to a rope grab, rip- stitch lanyard, a specially woven lanyard, tearing or deforming lanyard, automatic self - retraction lifeline lanyard, / which serves to dissipate a substantial amount of energy during a fall arrest. F. Deceleration Distance: The additional vertical distance a falling employee travels excluding lifeline elongation and free fall distance, before stopping, from the point at which the deceleration device begins to operate. It is measured at the distance between 1

the location of the employee's body harness attachment point at the moment of activation of the deceleration device during a fall, and the location of that attachment point after the employee comes to a full stop. c 2'' G. Free Fall: The act of falling before a personal fall arrest system begins to apply force to arrest the fall. H. Free Fall Distance: The vertical displacement of the fall arrest attachment point on the employee's body harness between the onset of the fall and just before the system begins to apply force to arrest the fall. Free fall- distance must not exceed six (6) feet. This distance excludes deceleration distance and lifeline lanyard / elongation distance. Full Body Harness: Webbing straps / which are secured about the body in a manner that will distribute the fall arrest forces over the thighs, pelvis, waist, chest and shoulders. This harness includes the ability to attach it to other components of a personal fall arrest system, preferably at the shoulders and /or middle of the back. J. Guardrail System: A barrier erected to prevent employees from falling to lower levels. This system includes a toe board, mid -rail, and top rail - able to withstand 200 pounds of force applied in any direction. K. Lanyard: A flexible line of rope or strap that has self- locking snap -hook connectors at each end for connecting to a body harness, deceleration device, and anchor points. L. Leading Edge: The edge of a floor, roof, or other walking/working surfaces, which change location as additional floor, roof, or other walking /working surface, is placed or constructed. A leading edge is considered an unprotected side or edge when not under active construction. M. Lifeline: A component consisting of a flexible line for connection to an anchorage at one end to hang vertically (vertical lifeline) or for connection to anchorage at both ends to stretch horizontally (horizontally lifeline). This serves as a means for connecting other components of a personal fall arrest system to the anchorage. N. Personal Fall Arrest System: A system used to arrest (catch) an employee in a fall from a working level. It consists of an anchorage location, connectors, and a body harness. It may also include a lanyard, deceleration device, lifeline, or any combination of the before - mentioned items. 0. Qualified Person: An individual, who by possession of a recognized degree, certificate, or professional standing or who by extensive knowledge, training, and experience, has successfully demonstrated his /her ability to resolve problems relating to the subject matter, work, or project. P. Rope Grab: A deceleration device, which travels on a lifeline and automatically, by friction, engages the lifeline and locks to arrest the fall. Q. Sna -hook: A connector comprised of a hook - shaped member with a closed keeper which may be open to permit the hook to receive an object and, when released, automatically closes to retain the object. Snap -hooks must be self- closing with a self - locking keeper which remains closed and locked until unlocked and pressed open for 2

I r, 1 connection or disconnection, thus preventing the opportunity for the object to roll out of the snap -hook. R. Toe Board: A low protective barrier that will prevent the fall of materials and equipment to a lower level, usually four (4) inches or greater in height. S. Total Fall Distance: The maximum vertical change in distance from the bottom of an individual's feet at the onset of a fall to the position ofthe feet at the fall arrest. This includes the free fall distance and the deceleration distance. T. Unprotected Sides and Edges: Any side or edge of a walking or working surface (e.g., floor, roof, ramp, and runway) where there is no guardrail at least 39 inches high. IV. DISCUSSION A. Types of Fall Protection Systems 1. An articulating man lift provided with a restraint system and full body harness to an anchor point below the waist (preferably at floor level). 2. Guardrail with a toe board, mid -rail and top rail. - 3. Personal fall arrest systems. Anchor points (rated at 5,000 pounds per person). Full body harness. Restraint line or lanyard. Retractable lanyard. Rope grabs. Connectors (self locking - snap- hooks). 4. Engineered lifelines. 5. Warning lines (signal). 6. Safety nets. 7. Safety monitors systems. B. Fall Protection Locations Fall protection is require wherever the potential exists to fall six (6) feet or more when involved in construction activities; four (4) feet when involved in general activities; and 10 feet when on a ladder. Examples include: 1. All flat and low sloped roof locations, when within six (6) feet of the roof edge or during roof repair /maintenance (4:12 pitch or less). 2. All exterior and interior equipment platforms, catwalks, antennas towers, / etc. 3. All exterior and interior fixed ladders above 20 feet. 3

J nr Li4ci 4. All mezzanine and balcony edges. 5. All open excavations or pits (greater than four (4) feet). 6. All tasks requiring use of articulating man lifts. 7. All tasks requiring employees or contractors to lean outside the vertical rails of ladders (e.g., painting, stairwell light bulb replacement). 8. Scaffolding erection (ten (10) feet in height or greater). 9. Mezzanine /catwalk areas whenever an employee must step outside the catwalk; additional fall protection (e.g., six (6) foot lanyard to full body harness, self retracting lanyard or rope grab system) must be used. C. Fall Protection Guidelines 1. Engineered Controls This should always be the first option selected whenever possible (e.g., light bulb changing telescoping arm, changing valve, relocate at ground level) or utilizing a contractor in extremely hazardous areas. 2. Guardrails On all projects, only guardrails made from steel, wood, and /or wire rope are to be used. All guardrail systems must comply with WISHA standards, as now promulgated or hereinafter adopted, (i.e., contain a 42" high top -rail, a mid -rail and toe board that can withstand 200 pounds of force in any direction). These guardrails will be placed in the following areas if necessary or feasible based on job location or requirements: a. On all open sided floors. b. Around all open excavations or pits. c. On leading edges of roofs or mezzanines. 3. Personal Fall Protection Systems All authorized persons on any project who will be required to wear a personal fall arrest or restraint system must comply with the following. a. A full body harness must be used at all times. b. Only shock absorbing lanyards or retractable lanyards may be used to keep impact forces at a minimum on the body. 4

c. Only nylon rope or nylon straps with locking snap -hooks are to be used for restraints. 1 023 d. All lanyards must have self locking - snap- hooks. e. The authorized person will inspect all personal arrest equipment once every year. Any deteriorated, bent, damaged or impacted equipment or harness showing excessive wear will be removed from service. 4. Fall Distance Consideration must be given to the total fall distance. The following factors can affect total fall distance: a. Length of connecting means (e.g., lanyard length, use of carabineers, snap - hooks). b. Position and height of anchorage relative to work platforms /area must be kept above the head whenever possible. c. Position of attachments and D -ring slide on the full body harness. d. Deployment of shock absorber (maximum 42 ") e. Movement in the lifeline. f. Initial position of worker before free fall occurs (e.g., sitting, standing, etc.). 5. Calculating Total Fall Distance The total fall distance is the total length of the shock absorbing lanyard + height of the person + the location distance at the end of the fall from the fall arrest point. Authorized persons must always allow a minimum of six (6) feet of clearance above the ground, walking/working surfaces or equipment from the fall arrest point to the end of the fall. 6. Engineered Lifeline Lifeline systems must be designed and approved by an engineer or qualified person. V. PROCEDURES 5

A. Inspection of Fall Protection Systems 0 2 o1 Fall Protection Systems will be maintained in good working condition through regular inspections. 1 Full Body Harness a. Employee shall inspect before each use: Closely examine all of the nylon webbing to ensure there are no burn marks which could weaken the material. Verify there are no torn, frayed, or broken fibers; pulled stitches; or frayed edges anywhere on the harness. Examine the D -ring for excessive wear, pits, deterioration, or cracks. Verify that the buckles operate correctly and are not deformed or cracked. Verify that additional punched holes have not been added. All rivets should be tight and not deformed. Check tongue /straps for excessive wear from repeated buckling. a. A competent person will complete and document an annual inspection of all harnesses. (See Appendix 1). b. Storage will consist of hanging the harness in an enclosed cabinet /shop to protect from damage and /or weathering. c. The competent person will inspect all harnesses that are involved in a fall. A determination will then be made as to whether to destroy the harness or to reuse the harness. 2. Lanyards /Shock Absorbing Lanyards a. Employee shall inspect before each use. Check lanyard material for cuts, burns, abrasions, kinks, knots, broken stitches, and excessive wear. Inspect the snap -hook for deterioration in the hook, locks, and eye. Ensure that all locking mechanisms seat and lock properly. Verify once locked, locking mechanism prevents hook from opening. Visually inspect shock absorbing for any signs of damage, paying close attention to where the shock absorber attaches to the lanyard. Verify that points where the lanyard attaches to the snap -hooks are free of defects. b. A competent person will complete and documents an annual inspection of all lanyards. (See Appendix 2). c. Storage will consist of hanging the lanyards in an enclosed cabinet and/ or shop to protect from damage or weathering. d. All lanyard involved in a fall will be destroyed. 6

3. Snap -hooks 1. 3 2 i a. Employee shall inspect before each use. Inspect snap -hook for any hook and eye distortions. Verify there are no cracks or pitted surfaces. Verify the keeper latch is not be bent, distorted, or obstructed. Verify that the keeper latch seats into the nose without binding. Verify that the keeper spring securely closes the keeper latch. Test the locking mechanism to verify that the keeper latch locks properly. b. A competent person will complete and documents an annual inspection of all snap- hooks. (See Appendix 3). c. All snap -hook involved in a fall will be destroyed. 4. Self-Retracting Lanyards /Lifelines a. Employee shall inspect before each use. Visually inspect to ensure there is no physical damage. Make sure all nuts and rivets are tight. Ensure the entire length of the nylon strap /wire rope is free from any cuts, burns, abrasions, kinks, knots, broken stitches /strands and excessive wear, and retracts freely. Test the unit by pulling sharply on the lanyard lifeline / to verify that the locking mechanism is operating correctly. b. A competent person will conduct and document pre -use inspection of all self - retracting lanyards lifelines. / (See Appendix 4). c. Service per manufacturer specifications (1-2 years). d. Inspect for proper function after every fall. Any lanyard showing excessive wear or damage will be destroyed. 5. Tie -Off Adapters /Anchorages a. Employees shall inspect for integrity and attachment to solid surface. b. A competent person will complete and document an annual inspection. c. All tie -offs and /or anchorages involved in a fall will be destroyed. 6. Articulating Man Lift/Boom lifts a. Employees shall inspect /service per manufacturer's guidelines before use: forklift, scissor lifts, forklift basket and safety nets. b. A competent person will complete and document an annual inspection of the aforementioned equipment.

9 r, r` n 7. Horizontal Lifelines a. Employees shall inspect before each use for structural integrity of line and anchors. b. A competent person will complete and document an annual inspection. 8. Guardrails a. Temporary - on a daily basis, a visual inspection will be completed by a competent person. b. Temporary systems - on a weekly basis, a complete structural inspection will be completed by a competent person. c. Permanent systems - annual structural inspections will be completed and documented by a competent person. Additional inspections may be required based on conditions /controls present. B. Storage and Maintenance of Fall Protection Equipment 1. Hang equipment in a cool, dry location in a manner that retains its shape. 2. Clean with mild, nonabrasive soap and hang dry. 3. Never use this equipment for any purpose other than personal fall arrest. 4. Once exposed to a fall, remove equipment from service immediately, until a competent person has inspected and had the equipment repaired, according to the manufactures specifications. C. Training Supervisor /Risk Manager /Safety Coordinators will ensure that all employees engaged in fall protection will be trained annually and have knowledge to: a. Recognize the fall hazard of/on their jobs. b. Understand the hazards associated with working near fall hazards. c. Work safely in hazardous areas by utilizing appropriate fall protection measures. d. Understand and follow all components of this fall protection program. e. Identify and understand the enforceable WISHA standards and American National Standards Institute (ANSI) standards that pertain to fall projection. 8

D. Rescue Procedures ri 1'2 1. Rescue Methods /Options of Fallen Person In the event that a fall arrest occurs on -site, personnel with an articulating man lift, bucket truck, or ladders, will rescue employees when feasible. Emergency services should be immediately contacted for alternative rescue. 2. Communication Issue In the event of a fall, the following people will be notified as soon as possible: a. Rescue personnel (Emergency services 911 if needed) b. Director/Manager /Supervisor c. Risk Manager E. Fall Investigation The following documentation will be completed as part of the fall investigation: a. Interview with staff and witnesses. F. Contractors b. Cowlitz County Accident Injury/Near / Miss report. All contractors will be required to follow the Cowlitz County Fall Protection Policy or demonstrate that their own procedures meet WISHA standards. 9

it J Full Body Harness Annual Inspection Checklist Appendix 1 Harness Model/Name: Serial Number: Shop /Vehicle Location Date of Manufacture: Date of Purchase General Factors / Supportive Details /Comments 1) Hardware: Includes D- Rings, buckles, keepers and back pads. Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion. 2) Webbing: Inspected for cuts, burns, tears, abrasions, frays, excessive soiling and discoloration. 3) Stitching: Inspect for pulled stitches. 4) Labels: Inspect, making certain all labels are securely held in place and are legible. 5) Other: 6) Other: 7) Corrective Action Taken: Competent Person Signature: Date Inspected 10

Appendix 2 Cl23 Lanyards Annual Inspection Checklist Harness Model/Name: Serial Number: Date of Manufacture: Shop /Vehicle Location Date of Purchase General Factors / Supportive Details /Comments 1) Hardware: Includes snap - hooks, carabineers, adjusters, keepers, thimbles, and D- rings. Inspect for damage, distortion, sharp edges, burrs, crack, corrosion and proper operation. 2) Webbing: Inspected for cuts, burns, tears, abrasions, frays, excessive soiling and discoloration. 3) Stitching: Inspect for pulled stitches. 4) Labels: Inspect, making certain all labels are securely held in place and are legible. 5) Synthetic Rope: Inspect for pulled or cut Yarns, burns, abrasions, knots, excessive soiling and discoloration. 6) Energy Absorbing component: Inspect, making certain all labels are securely held in place and are legible 7) Corrective Action Taken: Competent Person Signature: Date Inspected 11

Snap- hooks /Carabineers Annual Inspection Checklist 1 (., ( 1 Appendix 3 Harness Model/Name: Serial Number: Date of Manufacture: Shop /Vehicle Location Date of Purchase General Factors /Rej ected Supportive Details /Comments 1) Physical Damage: Inspect for cracks, sharp edges, burrs, deformities, and locking mechanism operations. 2) Excessive Corrosion: Inspect for corrosion, which affects the operation and /or the strength. 3) Stitching: Inspect for pulled stitches. 4) Markings: Inspect and make certain markings(s) are legible. 5) Other: 6) Other: 7) Corrective Action Taken: Competent Person Signature: Date Inspected 12

Harness ModeUName: Self - Retracting Lanyard /Lifeline Annual Inspection Checklist fl 1 1 * Appendix 4 o Serial Number: Shop /Vehicle Location Date of Manufacture: Date of Purchase General Factors / Supportive Details/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 or damage. 4) Lanyard /Lifeline: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration. 5) Locking Action: Inspect for proper lock -up ofbrake mechanism. 6) Retraction/Extension: Inspect spring tension by pulling lanyard out fully and allowing to retract fully lifeline must be taut with no slack). 7) Labels: Inspect, making certain all labels are securely held in place and are legible. 8) Corrective Action Taken: Competent Person Signature: Date Inspected 13