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Inspection Form SRL-Fillable

This inspection form is used to document the condition of a self-retracting lifeline. It includes sections to record whether the labels, markings, hardware, housing, lifeline, and fall indicator pass or fail various inspection criteria such as verifying labels are intact, hardware is free of damage, the housing shows no cracks, and the lifeline retracts properly and is free of cuts or fraying. Any notes can also be added to the form.

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prince olan
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Download as PDF, TXT or read online on Scribd
285 views

Inspection Form SRL-Fillable

This inspection form is used to document the condition of a self-retracting lifeline. It includes sections to record whether the labels, markings, hardware, housing, lifeline, and fall indicator pass or fail various inspection criteria such as verifying labels are intact, hardware is free of damage, the housing shows no cracks, and the lifeline retracts properly and is free of cuts or fraying. Any notes can also be added to the form.

Uploaded by

prince olan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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INSPECTION FORM

SELF-RETRACTING LIFELINE
Serial # Owner/Company:
Date of First Use: Inspector:
Date of Manufacture: Date of Inspection:

LABELS & MARKINGS Pass Fail


Anchor Point
Are labels intact & legible?
Are appropriate ANSI/OSHA/CSA
markings visible?
Housing
Are inspections are current/up-to-date?
Is date of first use documented?
HARDWARE (BUCKLES & D-RINGS) Pass Fail

Is fall indicator tripper?


Is connector free corrosion/cracks/pitting/
deformation?
Does connector latch seat into nose properly? Lifeline

Does connector spring firmly close latch?


Does connector keeper lock gate properly?
HOUSING Pass Fail

Is housing free of cracks/defects/blemishes?


Are all fasteners present/tight? Fall Indicator

Does anchor point rotate and undamaged?


Connector
LIFELINE Pass Fail

Is termination tight/undamaged?
Is cable free of cuts or fraying (100%)? NOTES

Does braking mechanism function


per design?
Does lifeline retract properly?
Are cable strands all intact?
Is buffer spring undamaged?
Does cable show excessive wear?

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