Serial Number(s):
Model Number:
Inspection Date:
Inspection: (See Section 2.2 for Inspection Frequency)
Component:
Harness Hardware
Inspect harness hardware including buckles (1), adjusters (2), D-rings (3), Easy-Link (4), loop keepers
(Diagram 1)
(5), lanyard parking (6), etc. These items must not be damaged, broken, or distorted, and must be free
of sharp edges, burrs, cracks, worn parts, or corrosion. PVC coated hardware must be free of cuts, rips,
tears, holes, etc. in the coating to ensure non-conductivity. Ensure buckles and adjusters work smoothly.
Webbing & Stitching
Inspect webbing; material must be free of frayed, cut, or broken fibers. Check for tears, abrasions, mold,
(Diagram 2)
burns, or discoloration. Inspect stitching; Check for pulled or cut stitches. Broken stitches may be an
indication that the harness has been impact loaded and must be removed from service.
Stitched Impact Indicators
The Stitched Impact Indicators are sections of webbing lapped back on themselves and secured with
(Diagram 3)
a specific stitch pattern. The stitch pattern is designed to release when the harness arrests a fall or is
exposed to equivalent force. If an Impact Indicator has been activated (indicated), the harness
must be removed from service and destroyed.
Labels
All labels should be present and fully legible. See Figures.
System & Subsystem
Inspect each system component or subsystem according to the manufacturer instructions.
Components
Diagram 1 – Hardware
1
3
6
4
2
1
5
1
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Corrective Action/Maintenance:
Table 1 – Inspection and Maintenance Log
5
1
6
2
1
5
1
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Approved By:
Date:
Date Purchased:
Date of First Use:
Inspected By:
Diagram 2 – Webbing
Cut
Frayed
Heavily
Soiled
Welding
Burns
25
User
Competent
Diagram 3 – Impact
Indicator
ü
Good
û
Indicated
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Next Inspection Due:
Person