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Horizontal Life Line Inspection Form

This document is an inspection form for horizontal lifelines. It contains sections to record information about the lifeline such as the manufacturer, model number, materials, and dates. It also has sections to document the results of an inspection of the lifeline hardware, material, connectors, tensioners, and shock absorbers. Inspectors check for issues like corrosion, cuts, broken strands, kinks, and proper labeling and record their results as passing or failing along with any notes. The purpose is to document the condition of the horizontal lifeline system.

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Selva Ganapathi
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3K views1 page

Horizontal Life Line Inspection Form

This document is an inspection form for horizontal lifelines. It contains sections to record information about the lifeline such as the manufacturer, model number, materials, and dates. It also has sections to document the results of an inspection of the lifeline hardware, material, connectors, tensioners, and shock absorbers. Inspectors check for issues like corrosion, cuts, broken strands, kinks, and proper labeling and record their results as passing or failing along with any notes. The purpose is to document the condition of the horizontal lifeline system.

Uploaded by

Selva Ganapathi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Inspection Form for Horizontal Lifelines

Inspection form

Manufacturer:

Model #:
horizontal lifelines
Owner / Company:

Lifeline Name of Inspector:


Description: Materials:
polyester Lifeline Signature:
Serial #: kernmantle Lifeline
cable Lifeline Date of Inspection:
Lot #:
length
Diameter In-Service Date:
Date of Manufacture:

Horizontal lifeline kit


labels & markings Pass fail Note (Kernmantle rope, Carabiners, rope tensioner, & O-rings)
Label (Intact & Legible)
Appropriate ANSI/OSHA/CSA Markings
Inspections are Current / Up-to-Date
Date of First Use

Hardware Pass fail Note Lifeline

Connector (Self-Closing & Locking)


Termination
Hook Gate / Tensioner / Rivets
O-Rings Connectors
Corrosion Label
Tensioner
Pitting / Nicks Shock Absorber

Material (rope or Cable) Pass fail Note


Confirm Proper Lifeline Threading Cable horizontal lifeline system
(cable, web tensioner, Impact attenuator, & O-rings)
Broken / Missing / Loose Stitching
Termination (Stitch, Splice, or Swage) Connector
Excessive Wear (Fraying or Broken Strands)
Tensioner
Cuts / Burns / Holes Labels
O-Rings
Kinks
Separation / Bird-Caging
Impact
Connector Attenuator
shock pack (if present) Pass fail Note
Cover / Shrink Tube (Don’t Cut or Remove) Lifeline
Termination
Damage / Fraying / Broken Stitching
Impact Indicator (Signs of Deployment)

Notes

Docket # HLL001

Distributed by Engineered Fall Protection | [email protected] | (314) 492-4422 | www.engineeredfallprotection.com

Inspection form Manufacturer: Model #: Description: Serial #: Lot #: Date of Manufacture: Owner / Company: Name of Inspector:

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