Safety Lanyard Inspection Form
Complete this form to document the inspection of safety lanyards and ensure compliance with safety standards.
Inspector Full Name
*
First Name
Last Name
Inspector Email Address
*
example@example.com
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Worksite or Location
*
Lanyard Serial Number
*
Lanyard Manufacturer
Lanyard Type
*
Please Select
Shock-absorbing
Restraint
Retractable
Other
Inspection Checklist
*
Rows
Pass
Fail
Webbing/Straps: No cuts, fraying, or excessive wear
1
2
Stitching: No loose, broken, or pulled threads
3
4
Hardware: No cracks, deformation, or corrosion
5
6
Labels/Tags: Present and legible
7
8
Shock Absorber: Intact, no signs of deployment
9
10
Connectors/Clips: Function properly, no damage
11
12
Additional Comments or Observations
Overall Condition of Lanyard
*
Pass – Lanyard is safe for use
Fail – Remove from service
Corrective Actions Taken (if any)
Inspector Signature
*
Submit Inspection
Submit Inspection
Should be Empty: