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Full Body Harness Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Harness Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Hardware: (includes D-rings, buckles, keepers, and back pads) Inspect for damage, distortion, sharp edges, burrs, cracks and corrosion.
Accepted
Rejected
2.) Webbing: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling, and discoloration.
Accepted
Rejected
3.) Stitching: Inspect for pulled or cut stitches.
Accepted
Rejected
4.) Labels: Inspect, make certain all labels are securely held in place and legible.
Accepted
Rejected
5.)
Accepted
Rejected
6.)
Accepted
Rejected
7.)
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Lanyards Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Lanyard Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Hardware: (includes snap hooks, carabiners, adjusters, keepers, thimbles,
and D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, corrosion and proper operation.
Accepted
Rejected
2.) Webbing: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling, and discoloration.
Accepted
Rejected
3.) Stitching: Inspect for pulled or cut stitches.
Accepted
Rejected
4.) Synthetic Rope: Inspect for pulled or cut yarns, burns, abrasion, knots, excessive soiling and discoloration.
Accepted
Rejected
5.) Wire Rope: Inspect for broken wires, corrosion, kinks, and separation of strands.
Accepted
Rejected
6.) Energy Absorbing Component: Inspect for elongation, tears, and excessive soiling.
Accepted
Rejected
7.) Labels: Inspect, make certain all labels are securely held in place and legible.
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Hooks / Carabiners Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Hook / Carabiner Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Physical Damage: Inspect for cracks, sharp edges, burrs, deformities and locking operation.
Accepted
Rejected
2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.
Accepted
Rejected
3.) Markings: Inspect, make certain marking(s) are legible.
Accepted
Rejected
4.)
Accepted
Rejected
5.)
Accepted
Rejected
6.)
Accepted
Rejected
7.)
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Tie-Off Adaptors Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Tie-Off Adaptor Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Hardware: (includes D-rings). Inspect for damage, distortion, sharp edges, burrs, cracks, and corrosion.
Accepted
Rejected
2.) Webbing: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling, and discoloration.
Accepted
Rejected
3.) Stitching: Inspect for pulled or cut stitches.
Accepted
Rejected
4.) Labels: Inspect, make certain all labels are securely held in place and legible.
Accepted
Rejected
5.)
Accepted
Rejected
6.)
Accepted
Rejected
7.)
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Anchorage Plates Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Anchorage Plate Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Physical Damage: Inspect for cracks, sharp edges, burrs, and deformities.
Accepted
Rejected
2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strength.
Accepted
Rejected
3.) Fasteners: Inspect for corrosion, tightness damage, and distortion. If welded, inspect weld for corrosion, cracks, and damage.
Accepted
Rejected
4.) Markings: Inspect, make certain marking(s) are legible.
Accepted
Rejected
5.)
Accepted
Rejected
6.)
Accepted
Rejected
7.)
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Self Retracting Lifelines Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Self Retracting Lifeline Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Owner/Dept./Location:
Owner's I.D. no.:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Impact Indicator: Inspect indicator for
activation (rupture of red stitching, elongated indicator, etc.).
Accepted
Rejected
2.) Screws / Fasteners: Inspect for damage
and make certain all screws and fasteners
are tight.
Accepted
Rejected
3.) Housing: Inspect for distortion, cracks, and other damage. Inspect anchoring loop for distortion and damage.
Accepted
Rejected
4.) Lifeline: Inspect for cuts, burns, tears, abrasion, frays, excessive soiling and discoloration, broken wires (see impact indicator section).
Accepted
Rejected
5.) Locking Action: Inspect for proper lock-up of brake mechanism.
Accepted
Rejected
6.) Retraction / Extension: Inspect spring tension by pulling lifeline out fully and allowing to retract fully (lifeline must be
taut, no slack).
Accepted
Rejected
7.) Hooks / Carabiners: Inspect for physical damage, corrosion, proper operation, and markings (see separate checklist/log for hooks/carabiners).
Accepted
Rejected
8.) Reserve Lifeline: Inspect reserve lifeline retention system for deployment.
Accepted
Rejected
9.) Labels: Inspect, make certain all labels are securely held in place and legible.
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Winch / Tripod / Davit Arm Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Winch: Inspect cable assembly, snap hooks, counter weight. Check for cuts, damage, broken wires, etc.
Accepted
Rejected
2.) Winch: Inspect ratchet brake, handle brake and drum brake, for operation, inspect teeth of drum for wear.
Accepted
Rejected
3.) Winch: Inspect housing for damage, check oil level, inspect mounting bracket (pin operation), and inspect fasteners.
Accepted
Rejected
4.) Winch: Inspect handle operation on low
and high speed shaft. Check raising and
lowering operations.
Accepted
Rejected
5.) Tripod: Inspect all bolts/nuts, check leg
locking action, inspect leg chains, adjustable legs, pins and heads.
Accepted
Rejected
6.) Davit Arm: Inspect all bolts, nuts and pins, inspect tubing/pulleys for damage,
and inspect base.
Accepted
Rejected
7.)
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Rescue Positioning Device Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
RPD Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Housing: Inspect for cracks, sharp edges, burrs, and deformities. Check anchorage loop for damage.
Accepted
Rejected
2.) Excessive Corrosion: Inspect for corrosion which effects the operation and/or strengths.
Accepted
Rejected
3.) Fasteners: Inspect for corrosion, tightness, damage, and distortion.
Accepted
Rejected
4.) Rope: Inspect for cuts, burns, abrasion, frays, excessive soiling. Inspect end terminations.
Accepted
Rejected
5.) Pulleys: Inspect for cracks or distortion.
Accepted
Rejected
6.) Accessories: Inspect sling, rescue harness, carabiners, and storage bag.
Accepted
Rejected
7.) Markings: Inspect, make certain marking(s) are legible.
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Rescumatic (SD100) Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
SD100 Model: x (length) Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Cover: Inspect for cracks, dents, and deformities.
Accepted
Rejected
2.) Rope: Inspect for wear, cuts, burns, soiling. Inspect end terminations.
Accepted
Rejected
3.) Fasteners: Inspect for corrosion, tightness, damage, and distortion.
Accepted
Rejected
4.) Mechanical Components: Inspect gears, brake shoes, brake drum for wear,
corrosion, and damage.
Accepted
Rejected
5.) Frame: Inspect for corrosion, wear or damage.
Accepted
Rejected
6.) Accessories: Inspect carabiners, rescue slings, and storage bag.
Accepted
Rejected
7.) Markings: Inspect, make certain marking(s) are legible.
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066
Model:
Manufacture Date:
Serial Number:
Lot Number:
Purchase Date:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.)
Accepted
Rejected
2.)
Accepted
Rejected
3.)
Accepted
Rejected
4.)
Accepted
Rejected
5.)
Accepted
Rejected
6.)
Accepted
Rejected
7.)
Accepted
Rejected
Overall Disposition Accepted
Rejected
Inspected By:
Date Inspected:
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