Copyright Safewaze 2022
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Label (Intact and Legible)
Appropriate ANSI / OSHA / CSA Markings
Inspections are Current / Up-to-Date
Date of First Use
PASS FAIL NOTE
LABELS & MARKINGS
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
Attachment Point
Nuts / Bolts / Rivets / Screws
Evidence of Damage (Dents / Cracks / Rust)
HOUSING
PASS FAIL NOTE
Connector (Self-Closing & Locking)
Impact Indicator
Hook Body / Rivets
Corrosion
Pitting / Nicks
CONNECTORS
PASS FAIL NOTE
Termination (Stitch, Splice, or Swage)
Cuts / Fraying / Broken Stitching
Excessive Wear
Cable Separating / Bird-Caging
Entire Length Retracts Smoothly
Test Braking / Locking Function
LIFELINE (WEB OR CABLE)
SELF-RETRACTING DEVICES
INSPECTION FORM
SELF-RETRACTING DEVICES
Model Number:
Name of Inspector:
Serial Number:
Description:
Signature:
Lot Number:
Date of Inspection:
Date of Manufacture:
Lifeline Material:
In-Service Date:
Company:
Manufacturer:
Galvanized Steel
Stainless Steel
Web
NOTES
225 Wilshire Avenue SW, Concord NC 28025
•
800-230-0319
•
www.safewaze.com
Attachment
Point
Connector
Impact
Indicator
Screws
Shock Pack
(if present)
Housing
