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Manufacturer:
Model Number:
Description:
Serial Number:
Lot Number:
Date of Manufacture:
LABELS & MARKINGS
Label (Intact and Legible)
Appropriate ANSI / OSHA Markings
Inspections are Current / Up-to-Date
Date of First Use
HARDWARE
Connector (Self-Closing and Locking)
Hook Gate / Rivets
Corrosion
Pitting / Nicks
MATERIAL (ROPE OR CABLE)
Broken / Missing / Loose Stitching
Termination (Stitch, Splice or Swage)
Excessive Wear (Fraying or Broken Strands)
Cuts / Burns / Holes
Kinks
Separation / Bird-Caging
SHOCK PACK (IF PRESENT)
Cover / Shrink Tube (Don't Cut or Remove)
Damage / Fraying / Broken Stitching
Impact Indicator (Signs of Deployment)
ROPE GRAB (IF PRESENT)
Locks on Lifeline Automatically
Moves Freely When Disengaged
No Visible Damage, Rust or Corrosion
225 Wilshire Avenue SW, Concord NC 28025
Company:
Name of Inspector:
Signature:
Date of Inspection:
In-Service Date:
Lifeline
Material:
PASS FAIL NOTE
Absorber
PASS FAIL NOTE
Positioning Device /
PASS FAIL NOTE
PASS FAIL NOTE
NOTES
PASS FAIL NOTE
•
If equipment fails inspection
IMMEDIATELY REMOVE FROM SERVICE
V5.0 2023 Copyright Safewaze
INSPECTION FORM
Cable
Kernmantle Rope
Length:
VERTICAL LIFELINE ASSEMBLY
Shock
Label
Extension
Lanyard
Termination
Rope Grab
Lifeline
VERTICAL LIFELINE
800-230-0319
•
VERTICAL LIFELINES
Twisted Rope
Diameter:
Connector
Label
Positioning Device /
Rope Grab
Termination
Connector
Lifeline
www.safewaze.com
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