Agency: Location: Date of Inspection: Inspected By: Signature: Date: Safety Harness Manufacturer and Serial No. Pass Pass 1. 9. Yes No Yes No Pass Pass 2. 10. Yes No Yes No Pass Pass 3. 11. Yes No Yes No Pass Pass 4. 12. Yes No Yes No 5. Pass 13. Pass Yes No Yes No Pass Pass 6. 14. Yes No Yes No Pass Pass 7. 15. Yes No Yes No 8. Pass 16. Pass Yes No Yes No A competent person must utilize the questions on “Checklist Guide” to determine if harnesses and lanyards meet satisfactory requirements.
Agency: Location: Date of Inspection: Inspected By: Signature: Date: Safety Harness Manufacturer and Serial No. 1. Pass Yes No 9. Pass Yes No 2. Pass Yes No 10. Pass Yes No 3. Pass Yes No 11. Pass Yes No 4. Pass Yes No 12. Pass Yes No 5. Pass Yes No 13. Pass Yes No 6. Pass Yes No 14. Pass Yes No 7. Pass Yes No 15. Pass Yes No 8. Pass Yes No 16. Pass Yes No A competent person must utilize the questions on “Checklist Guide” to determine if harnesses and lanyards meet satisfactory requirements.