Fall Protection Inspection Form

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Name

First NameLast Name

Is this a Subcontractor or IWS employee/affiliate filling out the form

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example@example.com

All parts of body harness and attachments are to be checked for excessive wear and damage. Body harness shall be visually inspected prior to each use.

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Body Harness

Rows	Satisfactory	Not Satisfactory	Cause for Removal From Service
Harness Webbing
All Stitching
Rivets and Eyelets
D-rings & Buckle
Body Pad (if applicable)
Lanyard Carabineer
Fall Warning Tag Intact
No Cuts, Corrosion, Burning
Overall Condition

Fall Protection Systems

Rows	Satisfactory	Not Satisfactory	Cause for Removal From Service
Vertical Lifeline
Horizontal Lifeline
Warning Lines
Guard Rails
Retractable Lanyards
Hole Covers
Positioning Devices

Signature