Project Information Project Name: Level/ Floor: Location: Grid line: Company name : Date: Life line check point Line No. Line No. Line No. Line No: Life line to be installed by competent erector and inspected prior use Wire rope free from damage / broken wires Minimum 12 mm diameter wire rope with breaking strength of 89 kN Wire rope not corroded/ rusted No kinks available No reduction in diameter No birdcage available Both vertical pipes at ends provided at diagonal bracing Platform secured with ladders 3 bull dog clips provided at end joints and properly clamped No joints available in life line No deformity on formwork scaffold Safe Distance between two life lines is maintained. Away from electrical lines Valid third party certificate available for installed lifeline Others ( Specify) Remarks: This checklist to be completed for both Shift Inspector Name: Signature: Reviewed By HSE Manager / In charge Signature:

1. LIFE LINE INSPECTION RECORD
(To be completed on daily basis)
Page 1 of 1 Form # HSEQ- LLIR (Rev 2 Mar 23)
Project Information
Project Name: Level/ Floor:
Location: Grid line:
Company name : Date:
Life line check point Line No. Line No. Line No. Line No:
Life line to be installed by competent erector and inspected prior use
Wire rope free from damage / broken wires
Minimum 12 mm diameter wire rope with breaking strength of 89 kN
Wire rope not corroded/ rusted
No kinks available
No reduction in diameter
No birdcage available
Both vertical pipes at ends provided at diagonal bracing
Platform secured with ladders
3 bull dog clips provided at end joints and properly clamped
No joints available in life line
No deformity on formwork scaffold
Safe Distance between two life lines is maintained.
Away from electrical lines
Valid third party certificate available for installed lifeline
Others ( Specify)
Remarks:
This checklist to be completed for both Shift
Inspector Name: Signature:
Reviewed By HSE Manager / In charge Signature: