V1.0 2022 Copyright Safewaze
If equipment fails inspection
IMMEDIATELY REMOVE FROM SERVICE
Label (Intact and Legible)
Appropriate ANSI / OSHA Markings
Inspections are Current / Up-to-Date
Date of First Use
PASS FAIL NOTE
LABELS & MARKINGS
PASS FAIL NOTE
Connector (Self-Closing and Locking)
Hook Gate / Rivets
Corrosion
Pitting / Nicks
HARDWARE
PASS FAIL NOTE
Cover / Shrink Tube (Don’t Cut or Remove)
Damage / Fraying / Broken Stitching
Impact Indicator (Signs of Deployment)
SHOCK PACK (IF PRESENT)
PASS FAIL NOTE
Locks on Lifeline Automatically
Moves Freely When Disengaged
No Visible Damage, Rust or Corrosion
ROPE GRAB (IF PRESENT)
PASS FAIL NOTE
Broken / Missing / Loose Stitching
Termination (Stitch, Splice or Swage)
Excessive Wear (Fraying or Broken Strands)
Cuts / Burns / Holes
Kinks
Separation / Bird-Caging
MATERIAL (ROPE OR CABLE)
INSPECTION FORM
VERTICAL LIFELINES
Model Number:
Name of Inspector:
Serial Number:
Description:
Signature:
Lot Number:
Date of Inspection:
Date of Manufacture:
Lifeline
Material:
In-Service Date:
Company:
Manufacturer:
Length:
Diameter:
Cable
Kernmantle Rope
Twisted Rope
225 Wilshire Avenue SW, Concord NC 28025
•
800-230-0319
•
www.safewaze.com
VERTICAL LIFELINE ASSEMBLY
VERTICAL LIFELINE
NOTES
Connector
Termination
Termination
Label
Extension
Lanyard
Positioning Device /
Rope Grab
Lifeline
Lifeline
Positioning Device /
Rope Grab
Label
Connector
Shock
Absorber
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