V1.0 2022 Copyright Safewaze
Label (Intact and Legible)
Appropriate ANSI / OSHA / CSA Markings
Inspections are Current / Up-to-Date
Date of First Use
Impact / Fall Indicators Not Deployed
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
Shoulder / Chest / Leg / Back Straps
Cuts / Burns / Holes
Paint Contamination
Excessive Wear
Heat / UV Damage
Shoulder / Chest / Leg / Back Straps
PASS
PASS
PASS
PASS
FAIL
FAIL
FAIL
FAIL
NOTE
NOTE
NOTE
NOTE
LABELS & MARKINGS
HARDWARE
(Buckles & D-Rings)
WEBBING
STITCHING
CONSTRUCTION HARNESS
FULL BODY HARNESS
INSPECTION FORM
HARNESSES
Model Number:
Name of Inspector:
Harness Configuration
:
Serial Number:
Description:
Signature:
Lot Number:
Date of Inspection:
Date of Manufacture:
In-Service Date:
Company:
Manufacturer:
PT
PT
Yes No
TB
TB
Chest
Strap
Leg
Straps
Waist
Belt
NOTES
Shoulder
Straps
Adjustment
Buckles
Side
D-Rings
Waist Belt
Leg Straps
Labels
Dorsal
D-Ring
Back
Strap
Impact Indicators
Chest
Strap
LOAD INDICATOR
LOAD INDICATOR
STOP
REMOVE FROM
SERVICE
LOAD INDICATOR
LOAD INDICATOR
STOP
REMOVE FROM
SERVICE
225 Wilshire Avenue SW, Concord NC 28025
•
800-230-0319
•
www.safewaze.com
13
14
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.
If equipment fails inspection
IMMEDIATELY REMOVE FROM SERVICE
17.0 INSPECTION FORM
