Harness Checklist Sl. No ………. Sl. No ………. Sl. No ………. Sl. No ………. Sl. No ………. Sl. No ………. Sl. No ………. Sl. No ………. Sl. No ………. Remarks Shoulder Straps Chest & Back Straps Waist Straps Back D-Ring Shoulder Adjustment Legible Label Shoulder Straps Chest & Back Straps Waist Straps Leg Straps Cuts Burns Holes Deterioration Corrosive/ worn out Color code Others (Specify) Project Information Project Name: Location: Company name : Date: Remarks: Inspector Name: Signature: Reviewed By HSE Manager / Incharge Signature:

1. FULL BODY SAFETY HARNESS INSPECTION RECORD
(To be completed on monthly basis)
Page 1 of 1 Form # HSEQ- FBHIR (Rev 2 - Mar 23)
Harness Checklist Sl. No
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Sl. No
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Sl. No
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Sl. No
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Sl. No
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Sl. No
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Sl. No
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Sl. No
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Sl. No
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Remarks
Shoulder Straps
Chest & Back Straps
Waist Straps
BackD-Ring
ShoulderAdjustment
Legible Label
Shoulder Straps
Chest & Back Straps
Waist Straps
Leg Straps
Cuts
Burns
Holes
Deterioration
Corrosive/ worn out
Color code
Others (Specify)
Remarks:
Inspector Name: Signature:
Reviewed By HSE Manager / Incharge Signature:
Project Information
Project Name: Location:
Company name : Date: