Lifeline Installation Inspection Form
Use this form to record and review the condition, safety checks, defects, and follow-up actions for a lifeline installation inspection.
Job and Inspector Information
Site / Project Name
*
Installation Address / Location Description
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
*
Inspector Company / Organization
Contact Phone or Email
*
Lifeline System Details
Lifeline Type
*
Please Select
Horizontal Lifeline
Vertical Lifeline
Temporary Lifeline
Permanent Lifeline
Other
Manufacturer or System Name
Installation Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Anchor Points
*
General System Condition
*
Good
Minor Issues
Needs Repair
Unsafe
Inspection Checklist
Anchor / attachment condition
*
Pass
Fail
Needs review
Cable / line condition
*
Pass
Fail
Needs review
Tension / slack condition
*
Acceptable
Too loose
Too tight
Unknown
Clearance and alignment check
*
Pass
Fail
Needs review
Corrosion / wear / damage observed
*
None
Minor
Moderate
Severe
Overall inspection status / result
*
Pass
Conditional pass
Fail
Defects, Actions, and Follow-Up
Defects or observations found
*
Corrective actions required
*
Immediate hazards present
*
Yes
No
Equipment taken out of service
*
Yes
No
Recommended reinspection or follow-up date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final remarks or notes
Submit Inspection
Should be Empty: