INSPECTION FORM
SELF-RETRACTING LIFELINE
Serial # Owner/Company:
Date of First Use: Inspector:
Date of Manufacture: Date of Inspection:
LABELS & MARKINGS Pass Fail
Anchor Point
Are labels intact & legible?
Are appropriate ANSI/OSHA/CSA
markings visible?
Housing
Are inspections are current/up-to-date?
Is date of first use documented?
HARDWARE (BUCKLES & D-RINGS) Pass Fail
Is fall indicator tripper?
Is connector free corrosion/cracks/pitting/
deformation?
Does connector latch seat into nose properly? Lifeline
Does connector spring firmly close latch?
Does connector keeper lock gate properly?
HOUSING Pass Fail
Is housing free of cracks/defects/blemishes?
Are all fasteners present/tight? Fall Indicator
Does anchor point rotate and undamaged?
Connector
LIFELINE Pass Fail
Is termination tight/undamaged?
Is cable free of cuts or fraying (100%)? NOTES
Does braking mechanism function
per design?
Does lifeline retract properly?
Are cable strands all intact?
Is buffer spring undamaged?
Does cable show excessive wear?
