Fall Protection
Full Body Harnesses
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 dam-
age, distortion, sharp edges, burrs, cracks
and corrosion.
2. Webbing: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling and dis-
coloration.
3. Stitching: Inspect for pulled or cut
stitches.
4. Labels: Inspect, make certain all labels are
securely held in place and legible.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
Inspection Checklist/Logs
Appendix
Release 2, October 2017
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
2 Appendix: Inspection Checklist/Logs- Release 2, October 2017
3M Personal Safety Division
Lanyards
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.
2. Webbing: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling and
discoloration.
3. Stitching: Inspect for pulled or cut
stitches.
4. Synthetic Rope: Inspect for pulled or cut
yarns, burns, abrasion, knots, excessive
soiling and discoloration.
5. Wire Rope: Inspect for broken wires,
corrosion, kinks and separation of strands.
6. Energy Absorbing Component: Inspect
for elongation, tears and excessive soiling.
7. Labels: Inspect, make certain all labels are
securely held in place and legible.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
Appendix: Inspection Checklist/Logs- Release 2, October 2017 3
3M Personal Safety Division
Tie-Off Adaptors
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.
2. Webbing: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling and
discoloration.
3. Stitching: Inspect for pulled or cut
stitches.
4. Labels: Inspect, make certain all labels are
securely held in place and legible.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
4 Appendix: Inspection Checklist/Logs- Release 2, October 2017
3M Personal Safety Division
Hooks/Carabiners
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.
2. Excessive Corrosion: Inspect for
corrosion which effects the operation
and/or strength.
3. Markings: Inspect, make sure certain
marking(s) are legible.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
Appendix: Inspection Checklist/Logs- Release 2, October 2017 5
3M Personal Safety Division
Anchorage Plates
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, deformities and locking
operation.
2. Excessive Corrosion: Inspect for
corrosion which effects the operation
and/or strength.
3. Fasteners: Inspect for corrosion, tightness,
damage and distortion. If welded, inspect
weld for corrosion, cracks and damage.
4. Markings: Inspect, make sure certain
marking(s) are legible.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
6 Appendix: Inspection Checklist/Logs- Release 2, October 2017
3M Personal Safety Division
Self Retracting Lifelines
Anchorage Plate Model: _________________________________________ Manufacture Date: _________________________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________________________
Comments: _____________________________________________________________________________________________
GENERAL FACTORS
ACCEPTED/
REJECTED
SUPPORTIVE DETAILS OR COMMENTS
1. Impact Indicator: Inspect indicator for
activation (rupture of red stitching, elon-
gated indicator, etc.)
2. Screws/Fasteners: Inspect for damage
and make certain all screws and fasteners
are tight.
3. Housing: Inspect for distortion, cracks and
other damage. Inspect anchoring loop for
distortion and damage.
4. Lifeline: Inspect for cuts, burns, tears,
abrasion, frays, excessive soiling and
discoloration, broken wires (see impact
indicator section).
5. Locking Action: Inspect for proper lock-
up of brake mechanism.
6. Retraction/Extension: Inspect spring
tension by pulling lifeline out fully and
allowing it to retract fully (no slack).
7. Hooks/Carabiners: Inspect for physical
damage, corrosion, proper operation and
markings (see separate checklist/log for
hooks and carabiners).
8. Reserve Lifeline: Inspect reserve lifeline
retention systems for deployment.
9. Labels: Inspect, make certain all labels are
securely held in place and legible.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
Appendix: Inspection Checklist/Logs- Release 2, October 2017 7
3M Personal Safety Division
Inspection Checklist/Log
______________ Model: _________________________________________ Manufacture Date: _________________________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________________________
Comments: _____________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
GENERAL FACTORS
ACCEPTED/
REJECTED
SUPPORTIVE DETAILS OR COMMENTS
1.
2.
3.
4.
5.
6.
7.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
ACCEPTED
REJECTED
8 Appendix: Inspection Checklist/Logs- Release 2, October 2017
3M Personal Safety Division
Inspection Checklist/Log
______________ Model: _________________________________________ Manufacture Date: _________________________
Serial Number: ______________________ Lot Number: _______________ Purchase Date: ____________________________
Comments: _____________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
GENERAL FACTORS
ACCEPTED/
REJECTED
SUPPORTIVE DETAILS OR COMMENTS
1.
2.
3.
4.
5.
6.
7.
Overall Disposition
INSPECTED BY: _____________________________________________
DATE INSPECTED: __________________________________________
3M Personal Safety Division
Fall Protection Equipment Inspection Log
Green: Pass, Safe for Use Red: Remove from Service - Send to Manufacturer for Inspection/Servicing Black: Destroy Immediately
SERIAL #
DATE
OF MFG.
MODEL # DESCRIPTION
INSPECTION
DATE
PASS FAIL
INSPECTED
BY
INSPECTION
DATE
PASS FAIL
INSPECTED
BY
INSPECTION
DATE
PASS FAIL
INSPECTED
BY
COMMENTS
Classification ____________________________ Company ____________________________