Fall Protection Equipment Inspection Form
Inspector Name
Date
Location
Equipment Information
Equipment Type
Manufacturer
Model/Serial No.
Date of Manufacture
Date of Last Inspection
Inspection Checklist
Inspection Item
Status
Comments
Webbing/Straps: cuts, fraying, burns, etc.
Pass
Fail
N/A
Stitching: pulled, cut, or worn threads
Pass
Fail
N/A
Buckles/Clips/Adjusters: cracks, deformation, corrosion
Pass
Fail
N/A
Labels/Tags: legible and present
Pass
Fail
N/A
Connectors/Lanyards: damage, wear, or deformities
Pass
Fail
N/A
Other (describe)
Pass
Fail
N/A
Additional Comments/Actions Required
Inspector Signature
Date