Label (Intact and Legible)

Appropriate ANSI / OSHA Markings

Inspections are Current / Up-to-Date

Date of First Use

PASS FAIL NOTELABELS & MARKINGS

PASS FAIL NOTE

Connector (Self-Closing and Locking)

Hook Gate / Tensioner / Rivets

Corrosion

Pitting / Nicks

HARDWARE

PASS FAIL NOTE

Cover / Shrink Tube (Don’t Cut or Remove)

Damage / Fraying / Broken Stitching

Impact Indicator (Signs of Deployment)

SHOCK PACK (IF PRESENT)

PASS FAIL NOTE

Confirm Proper Lifeline Threading

Broken / Missing / Loose Stitching

Termination (Stitch, Splice, or Swage)

Excessive Wear (Fraying or Broken Strands)

Cuts / Burns / Holes

Kinks

Separation / Bird-Caging

MATERIAL (ROPE OR CABLE)

INSPECTION FORMHORIZONTAL LIFELINES

Model Number: Name of Inspector:

Serial Number:

Description: Signature:

Lot Number:

Date of Inspection:

Date of Manufacture: Lifeline Material:

In-Service Date:

Company: Manufacturer:

Length: Diameter: Cable Kernmantle Rope Double Braided Rope

225 Wilshire Avenue SW, Concord NC 28025 • 800-230-0319 • www.safewaze.com

CABLE HORIZONTAL LIFELINE KIT

KERNMANTLE HORIZONTAL LIFELINE KIT

NOTES

O-Rings

Tensioner

ConnectorsLabels

Termination

Shock Absorber

Lifeline

Connectors

Shock Absorber

Turnbuckle Tensioner

O-Rings

Lifeline