Fall Protection Safety Checklist Form
Document your fall protection safety inspection using this streamlined checklist form.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Type of Fall Protection Equipment Inspected
*
Full Body Harness
Lanyard
Self-Retracting Lifeline
Anchorage Point
Other
Checklist: Inspection Items
*
Rows
Pass
Fail
N/A
Equipment free from damage and defects
1
2
3
Harness buckles and straps secure
4
5
6
Lanyard/hook functioning properly
7
8
9
Anchorage points inspected and secure
10
11
12
Labels and markings legible
13
14
15
Were any issues identified during the inspection?
*
No issues found
Yes, issues found
If yes, please describe the issues
Corrective Actions Taken (if any)
Additional Comments or Observations
Upload Inspection Photos (optional)
Upload a File
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of
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