Fall Protection Equipment Inspection Log

Personal Fall Arrest System (PFAS)
Equipment Inspection Log

OSHA 29 CFR 1926.502(d) · ANSI Z359.1 · NYC BC §3315 · Pre-Use Worker Inspection Required Daily

PL-018

Project Address
General Contractor		DOB Job No.
SSM Name		SSM License No.
Inspection Period / Year

GREEN = In Service & Compliant RED = Remove from Service — Tag & Store BLACK = Retired — Cut Webbing & Destroy PFAS equipment involved in an arrested fall must be taken out of service and retired (BLACK status) immediately — apparent condition is not a factor. ANSI Z359.1 §4.1.

#	Equip. ID / Serial No.	Type	Assigned Worker	Inspection 1			Inspection 2			Inspection 3			Mfr. Retire Date	Notes
#	Equip. ID / Serial No.	Type	Assigned Worker	Date	Status	Insp. By	Date	Status	Insp. By	Date	Status	Insp. By	Mfr. Retire Date	Notes
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Pre-use inspection criteria: webbing condition (cuts, abrasion, UV or chemical damage) · hardware integrity (corrosion, distortion, gate function) · stitching integrity (pulls, tears, fraying) · label readability · shock indicator status (retire immediately if deployed)

Competent Person (Inspection By — print)		Title
Signature		Date

SSM Review (print)		License No.
SSM Signature		Date