This document is an inspection form for a harness used in safety equipment. It contains sections to record the harness part number, serial number, dates of first use and manufacture, owner information, and inspector details. The form is then used to document the inspection of the harness components including hardware, webbing, stitching, labels and markings. Pass or fail ratings are given for each section along with any relevant notes.

1. Inspection form Harness
Harness Part #:
Serial #:
Date of First Use:
Date of Manufacture:
Owner / Company:
Name of Inspector:
Signature:
Date of Inspection:
Harness
Configuration:
Chest Strap:
Leg Straps:
waist belt:
PT
PT
yes
TB
TB
no
QC
QC
HARDWARE(BUCKLES&D-RINGS)
stitching
labels&markings
Webbing
Seraphconstructionharness
(ptchest,tbwaist,&tblegs)
Velocityharness
(PTchest&legs)
Shoulder Adjustment Buckles
Leg & Waist Buckles / Other Hardware
D-Rings (Dorsal, Side, Shoulder, or Sternal)
Corrosion / Pitting / Nicks
Shoulder / Chest / Leg / Back Straps
Label (Intact & Legible)
Appropriate ANSI/OSHA/CSA Markings
Inspections are Current / Up-to-Date
Date of First Use
Impact Indicator (Signs of Deployment)
Shoulder / Chest / Leg / Back Straps
Cuts / Burns / Holes
Paint Contamination
Excessive Wear
Heat / UV Damage
Pass
Pass
Pass
Pass
fail
fail
fail
fail
Note
Note
Note
Note
Notes
Shoulder Straps
Dorsal D-Ring
Chest Strap
Back Strap
Adjustment
Buckles
Impact
Indicators
Side D-Rings
Labels
Waist Belt
Leg Straps
85310 Rev.A
Connection
Legend:
PT: Pass-Through
Tb: Tongue Buckle
Qc: Quick-Connect