COMPANY NAME/LOGO
SITE ADDRESS
REGISTER FOR SAFETY HARNESSES
NAME/DEPT:
HARNESS NO:
INITIAL FOR OK:
CHECKLIST
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
WEBBING:
CLEAN
NO HEAT DAMAGE
NO CUTS
NO SEAM DAMAGE
NO OTHER PHYSICAL DAMAGE
METAL FITTINGS:
CABLE IN GOOD CONDITION
METAL LOOPS AND COUPLINGS IN
GOOD CONDITION
SHACKLES AND CLIPS IN GOOD
CONDITION
LIFE LINE/LANYARD CONNECTIONS
IN GOOD CONDITION
NO DEFORMATION OF HOOK
FITTINGS
SIGNATURE
INITIAL IN APPROPRIATE BOX
SAFETY HARNESS MAY BE USED
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
SAFETY HARNESS MAY NOT BE
USED
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO