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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