Full Body Harness

Inspection Checklist / Log 3965 Pepin Ave.

Red Wing, MN 55066

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 Accepted
damage, distortion, sharp edges, burrs, Rejected
cracks and corrosion.

2.) Webbing: Inspect for cuts, burns, tears, Accepted

abrasion, frays, excessive soiling, and
discoloration. Rejected

3.) Stitching: Inspect for pulled or cut Accepted

stitches. Rejected

4.) Labels: Inspect, make certain all labels Accepted

are securely held in place and legible. Rejected

5.)
Accepted
Rejected

6.)
Accepted
Rejected

7.)
Accepted
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Lanyards
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

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, Accepted
and D-rings). Inspect for damage,
distortion, sharp edges, burrs, cracks, Rejected
corrosion and proper operation.

2.) Webbing: Inspect for cuts, burns, tears, Accepted

abrasion, frays, excessive soiling, and
discoloration. Rejected

3.) Stitching: Inspect for pulled or cut Accepted

stitches. Rejected

4.) Synthetic Rope: Inspect for pulled or Accepted

cut yarns, burns, abrasion, knots,
excessive soiling and discoloration. Rejected

5.) Wire Rope: Inspect for broken wires,

corrosion, kinks, and separation of Accepted
strands.
Rejected

6.) Energy Absorbing Component: Accepted

Inspect for elongation, tears, and
excessive soiling. Rejected

7.) Labels: Inspect, make certain all labels Accepted

are securely held in place and legible.
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Hooks / Carabiners
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

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, Accepted

sharp edges, burrs, deformities and
locking operation. Rejected

2.) Excessive Corrosion: Inspect for Accepted

corrosion which effects the operation
and/or strength. Rejected

3.) Markings: Inspect, make certain Accepted

marking(s) are legible. Rejected

4.)
Accepted
Rejected

5.)
Accepted
Rejected

6.)
Accepted
Rejected

7.)
Accepted
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Tie-Off Adaptors
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

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 Accepted

for damage, distortion, sharp edges,
burrs, cracks, and corrosion. Rejected

2.) Webbing: Inspect for cuts, burns, tears, Accepted

abrasion, frays, excessive soiling, and
discoloration. Rejected

3.) Stitching: Inspect for pulled or cut Accepted

stitches. Rejected

4.) Labels: Inspect, make certain all labels Accepted

are securely held in place and legible. Rejected

5.)
Accepted
Rejected

6.)
Accepted
Rejected

7.)
Accepted
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Anchorage Plates
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

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, Accepted

sharp edges, burrs, and deformities. Rejected

2.) Excessive Corrosion: Inspect for Accepted

corrosion which effects the operation
and/or strength. Rejected

3.) Fasteners: Inspect for corrosion,

tightness damage, and distortion. If Accepted
welded, inspect weld for corrosion, Rejected
cracks, and damage.

4.) Markings: Inspect, make certain Accepted

marking(s) are legible. Rejected

5.)
Accepted
Rejected

6.)
Accepted
Rejected

7.)
Accepted
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Self Retracting Lifelines
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

Self Retracting Lifeline Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:
Owner/Dept./Location:
Owner's I.D. no.:
Comments:
General Factors Accepted / Rejected Supportive Details or Comments
1.) Impact Indicator: Inspect indicator for Accepted
activation (rupture of red stitching,
elongated indicator, etc.). Rejected

2.) Screws / Fasteners: Inspect for damage Accepted

and make certain all screws and fasteners
are tight. Rejected

3.) Housing: Inspect for distortion, cracks, Accepted

and other damage. Inspect anchoring
loop for distortion and damage. Rejected

4.) Lifeline: Inspect for cuts, burns, tears,

abrasion, frays, excessive soiling and Accepted
discoloration, broken wires (see Rejected
impact indicator section).

5.) Locking Action: Inspect for proper Accepted

lock-up of brake mechanism.
Rejected

6.) Retraction / Extension: Inspect spring

tension by pulling lifeline out fully and Accepted
allowing to retract fully (lifeline must be
taut, no slack). Rejected

7.) Hooks / Carabiners: Inspect for

physical damage, corrosion, proper Accepted
operation, and markings (see separate
checklist/log for hooks/carabiners). Rejected

8.) Reserve Lifeline: Inspect reserve Accepted

lifeline retention system for deployment. Rejected

9.) Labels: Inspect, make certain all labels Accepted

are securely held in place and legible. Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Winch / Tripod / Davit Arm
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

General Factors Accepted / Rejected Supportive Details or Comments

1.) Winch: Inspect cable assembly, snap Accepted

hooks, counter weight. Check for cuts,
damage, broken wires, etc. Rejected

2.) Winch: Inspect ratchet brake, handle Accepted

brake and drum brake, for operation,
inspect teeth of drum for wear. Rejected

3.) Winch: Inspect housing for damage, Accepted

check oil level, inspect mounting bracket
(pin operation), and inspect fasteners. Rejected

4.) Winch: Inspect handle operation on low Accepted

and high speed shaft. Check raising and
lowering operations. Rejected

5.) Tripod: Inspect all bolts/nuts, check leg Accepted

locking action, inspect leg chains,
adjustable legs, pins and heads. Rejected

6.) Davit Arm: Inspect all bolts, nuts and Accepted

pins, inspect tubing/pulleys for damage,
and inspect base. Rejected

7.)
Accepted
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Rescue Positioning Device
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

RPD Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

General Factors Accepted / Rejected Supportive Details or Comments

1.) Housing: Inspect for cracks, sharp Accepted

edges, burrs, and deformities. Check
anchorage loop for damage. Rejected

2.) Excessive Corrosion: Inspect for Accepted

corrosion which effects the operation
and/or strengths. Rejected

3.) Fasteners: Inspect for corrosion, Accepted

tightness, damage, and distortion. Rejected

4.) Rope: Inspect for cuts, burns, abrasion, Accepted

frays, excessive soiling. Inspect end
terminations. Rejected

5.) Pulleys: Inspect for cracks or distortion. Accepted

Rejected

6.) Accessories: Inspect sling, rescue Accepted

harness, carabiners, and storage bag.
Rejected

7.) Markings: Inspect, make certain Accepted

marking(s) are legible.
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Rescumatic (SD100)
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

SD100 Model: x (length) Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

General Factors Accepted / Rejected Supportive Details or Comments

1.) Cover: Inspect for cracks, dents, and Accepted

deformities. Rejected

2.) Rope: Inspect for wear, cuts, burns, Accepted

soiling. Inspect end terminations. Rejected

3.) Fasteners: Inspect for corrosion, Accepted

tightness, damage, and distortion. Rejected

4.) Mechanical Components: Inspect Accepted

gears, brake shoes, brake drum for wear,
corrosion, and damage. Rejected

5.) Frame: Inspect for corrosion, wear or Accepted

damage.
Rejected

6.) Accessories: Inspect carabiners, rescue Accepted

slings, and storage bag.
Rejected

7.) Markings: Inspect, make certain Accepted

marking(s) are legible.
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
Inspection Checklist / Log 3965 Pepin Ave.
Red Wing, MN 55066

Model: Manufacture Date:

Serial Number: Lot Number: Purchase Date:

Comments:

General Factors Accepted / Rejected Supportive Details or Comments

1.)
Accepted
Rejected

2.)
Accepted
Rejected

3.)
Accepted
Rejected

4.)
Accepted
Rejected

5.)
Accepted
Rejected

6.)
Accepted
Rejected

7.)
Accepted
Rejected

Accepted Inspected By:

Overall Disposition
Rejected Date Inspected:
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