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Horizontal Lifeline Inspection Checklist

This inspection form is used to document the inspection of horizontal lifeline systems. It includes fields to record information about the lifeline such as the manufacturer, model, serial number, and date of manufacture. It also includes sections to document the condition of the lifeline material, hardware, connectors, tensioners, and shock absorbers by indicating whether each passes or fails inspection. Any notes can also be added to describe issues.

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fredy salas
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204 views1 page

Horizontal Lifeline Inspection Checklist

This inspection form is used to document the inspection of horizontal lifeline systems. It includes fields to record information about the lifeline such as the manufacturer, model, serial number, and date of manufacture. It also includes sections to document the condition of the lifeline material, hardware, connectors, tensioners, and shock absorbers by indicating whether each passes or fails inspection. Any notes can also be added to describe issues.

Uploaded by

fredy salas
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

horizontal lifelines 1.800.466.6385


[email protected]

Manufacturer:
Owner / Company:
Model #:
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

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