### ![](media/image1.png){width="0.8333333333333334in" height="0.22916666666666666in"}

### ***U.S. Geological Survey Manual*** 

# ***Appendix 44-1 Part 445-2-H, Chapter 44***

**Sample Fall Protection Program**

![](media/image2.jpeg){width="3.535416666666667in" height="3.7375in"}

Revised October 2008

**Table of Contents**

[Page]{.underline}

Purpose and Scope 3

Goals 3

Definitions 3

Types of Fall Protection Systems 5

Fall Protection Locations 6

Fall Protection Guidelines - Options 7

Guardrails 7

Warning Line System 8

Personal Fall Protection System 8

Fall Protection Calculations 8

Total Fall Distance 9

Clearance 9

Engineered Lifeline 9

Inspection of Fall Protection Systems 9

Full Body Harnesses 9

Lanyards/Shock Absorbing Lanyards 10

Self-Retracting Lanyards 11

Snap Hooks and Carabiners 11

Tie-off Adapters/Anchor Points 12

Articulating Man Lift 12

Horizontal Lifelines 12

Guardrails 12

Storage and Maintenance of Fall Protection Equipment 12

Fall Protection Training 13

Rescue Procedures/Methods 13

Communication Issues 13

Fall Investigation 14

Fall Protection Program Evaluation 14

Contractors Guidelines 14

Appendix 1: Full Body Harness Annual Inspection Checklist 15

Appendix 2: Lanyards Annual Inspection Checklist 16

Appendix 3: Snap Hooks and Carabiners Inspection Checklist 17

Appendix 4: Self-Retracting Lanyard/Lifeline Annual Inspection Checklist
18

Appendix 5: Fall Protection Safety Training Record 19

**Purpose and Scope**

The purpose of this Fall Protection Program is to establish guidelines
to protect all USGS employees engaged in outdoor or indoor work
activities that expose them to potential falls from elevations. The
scope of this Fall Protection Program includes all agency owned or
leased buildings and projects funded by USGS and the USGS employees and
others for whom the Government assumes workers compensation liability
and whose duties may expose them to falls of 4 feet or more to a surface
below in general industry situations; 6 feet or more in construction or
construction-related activities; or to dangerous machinery from any
height. This includes volunteers covered by a properly executed USGS
Form 9-2080, Individual Volunteer Services Agreement, and students
acquired by purchase orders citing Public Law 106-113 as the authority
for the award, that work or come to these locations.

**Note**: Supervisors are to keep visitors (or volunteers not covered by
a Form 9-2080) away from such circumstances, as is customary at
construction or other hazardous sites where notices are posted and
visitors are not allowed to proceed at all or without proper protection.

**\
Goals**

The goal of this Fall Protection Program is to prevent falls from
heights. Falls from heights are the leading cause of death and
debilitating injury in the construction industry, and our Bureau
performs a number of tasks that expose employees to potential falls.
This goal will be accomplished through effective education, engineering
and administrative controls, use of fall protection systems, and
enforcement of the program. This Fall Protection Program will be
reviewed periodically and updated as necessary.

**Definitions**

***Anchor Point***. A secure point of attachment for lifelines,
lanyards, or deceleration devices. An anchor point must be capable of
supporting at least 5,000 pounds (3,600 pounds if engineered/ certified
by a qualified person) per person and must be independent of any anchor
point being used to support or suspend platforms.

***Authorized Person***. An individual approved or assigned by the USGS
to perform a specific type of duty or duties or to be at a specific
location or job site (e.g., building maintenance, roof repair, etc.).

***Carabiner.*** A metal loop (D ring) with a spring-hinged side that
can quickly and reversibly connect components in safety-critical
systems.

***Clearance***. The distance required to prevent the employee from
striking the next level or any other obstruction below.

***Competent Person***. An individual who is capable of identifying
existing or potential hazards in the surroundings or work areas and has
the authority to take prompt corrective action to eliminate such
hazards.

***Connector***. A device which is used to couple (connect) parts of the
personal fall arrest system.

***Deceleration Device***. Any mechanism, such as a rope grab,
rip-stitch lanyard, a specially woven lanyard, tearing or deforming
lanyard, automatic self-retracting lifeline/ lanyard, etc., which serves
to dissipate a substantial amount of energy during a fall arrest.

***Deceleration Distance***. The additional vertical distance a falling
employee travels, excluding lifeline elongation and free-fall distance,
before stopping and from the point at which the deceleration device
begins to operate. It is measured as the distance between the location
of an employee\'s body harness attachment point at the moment of
activation of the deceleration device during a fall and the location of
that attachment point after the employee comes to a full stop.

***Free Fall.*** The act of falling before a personal fall arrest system
begins to apply force to arrest the fall.

***Free-Fall Distance***. The vertical displacement of the fall arrest
attachment point on the employee\'s body harness between the onset of
the fall and just before the system begins to apply force to arrest the
fall. (The distance that a worker falls before engaging the fall arrest
system.) Free-fall distance must not exceed 6 feet.

***Full Body Harness***. Webbing/straps which are secured about an
employee\'s body in a manner that will distribute the fall arrest forces
over the thighs, pelvis, waist, chest, and shoulders. Having means for
attaching it to other components of a personal fall arrest system,
preferably at the shoulders and/or middle of the back.

***Guardrail System.*** A barrier erected to prevent employees from
falling to lower levels. This system includes a toe board, midrail, and
toprail able to withstand 200 pounds of force applied in any direction.

***Lanyard***. A flexible line of rope or strap that has self-locking
snap hook connectors at each end for connecting to body harnesses,
deceleration devices, and anchor points.

***Leading Edge.*** The edge of a floor, roof, or other walking/working
surface which changes location as an additional floor, roof, etc., is
placed or constructed. A leading edge is considered an unprotected side
or edge when not under active construction.

***Lifeline.*** A flexible line for connecting to an anchor point at one
end to hang vertically (vertical lifeline) or for connecting to anchor
points at both ends to stretch horizontally (horizontal lifeline).
Serves as a means for connecting other components of a personal fall
arrest system to the anchor point.

***Low Slope Roof.*** A roof having a slope of less than or equal to 4
in 12 (vertical to horizontal). A roof with approximately a 19.5 degree
slope or less.

***Personal Fall Arrest System.*** A system used to arrest (catch) an
employee in a fall from a working level. It consists of an anchor point
location, connectors, a body harness, and may include a lanyard,
deceleration device, lifeline, or any combination thereof.

***Qualified Person***. An individual, who, by possession of a
recognized degree, certificate, or professional standing, or who, by
extensive knowledge, training, and experience, has successfully
demonstrated his/her ability to solve or resolve problems relating to
the subject matter, work, or project.

***Rope Grab***. A deceleration device which travels on a lifeline and
automatically, by friction, engages the lifeline and locks to arrest the
fall of an employee.

***Roof Work.*** The hoisting, storage, installation, repair, and
removal of materials or equipment on the roof.

***Safety Monitoring System.*** A safety system in which a competent
person is responsible for recognizing and warning employees of potential
fall hazards. All other fall protection systems must be deemed
\"infeasible\" (through a study or review) before selecting or using a
safety monitoring system.

***Snap Hook.*** A connector comprised of a hook-shaped member with a
closed keeper which may be opened to permit the hook to receive an
object and when released, automatically closes to retain the object.
Snap hooks must be self-closing with a self-locking keeper which remains
closed and locked until unlocked and pressed open for connection or
disconnection, thus preventing the opportunity for the object to
\"rollout\" of the snap hook.

***Steep Slope Roof.*** A roof having a slope greater than 4 in 12
(vertical to horizontal). A roof with a slope greater than 19.5 degrees.

***Toe Board.*** A low protective barrier that will prevent the fall of
materials and equipment to lower levels, usually 4 inches or greater in
height.

***Total Fall Distance***. The maximum vertical change in distance from
the bottom of an individual\'s feet at the onset of a fall, to the
position of the feet after the fall is arrested. This includes the
free-fall and deceleration distances.

***Unprotected Sides and Edges.*** Any side or edge of a walking or
working surface (e.g., floor, roof, ramp, runway, etc.) where there is
no guardrail at least 39 inches high.

***Warning Line System***. A barrier erected on a roof to warn employees
that they are approaching an unprotected roof side or edge and
designates an area in which work can be conducted without the use of
guardrails, personal fall arrest systems, or safety nets to protect
employees in the area. This will be utilized on any roof greater than 50
feet wide and in conjunction with a safety monitor and only where the
other forms of fall protection have been deemed infeasible to use.

**Types of Fall Protection Systems**

Appropriate fall protection will be determined by the task to be
performed. Examples include:

1\. An articulating man lift provided with a restraint system and full
body harness attached to an anchor point below the waist (preferably at
the floor level).

2\. Guardrail with a toe board, midrail, and toprail.

3\. Personal fall arrest systems.

A. Anchor points (rated at 5,000 pounds per person).

B. Full body harness.

\(1\) Restraint line or lanyard.

\(2\) Retractable lanyard.

\(3\) Rope grabs.

\(4\) Connectors (self-locking snap hooks).

4\. Engineered lifelines.

5\. Warning lines.

6\. Safety nets.

7\. Safety monitoring systems.

**Fall Protection Locations**

Fall protection is required wherever the potential to fall 4 feet (6
feet for construction activities) or more exists. The *(\_\_\_\_\_\_\_
Science Center)* has identified the following places that require fall
protection: (examples)

1\. All flat and low sloped roof locations when working within 6 feet of
the roof's edge or during roof

repair/maintenance (4:12 pitch or less).

2\. All exterior and interior equipment platforms, catwalks, and
antennas/towers.

3\. All exterior and interior fixed ladders above 20 feet.

4\. All mezzanine and balcony edges.

5\. All open excavations or pits.

6\. All tasks requiring use of the articulating man lifts.

7\. All tasks requiring employees to lean outside the vertical rails of
ladders (e.g., painting, stairwell

lightbulb replacement, etc.).

8\. Scaffolding erection10 feet or greater in height.

9\. Cableways, bridge measurements.

10\. Communications towers.

Fall protection is not needed if an employee or employees are on a low
sloped roof for inspection/observation, provided that they do not
approach within 8 feet of the roof's edge.

**Fall Protection Guidelines - Options**

***Engineering Controls*.** Whenever possible, attempts should be made
to change the nature of the task so that it is not necessary to use fall
protection. Some examples would be: moving the task to ground level,
using a telescoping arm to reach an area (e.g., to change a lightbulb),
or use remote-sensing equipment rather than having to send a person into
harm's way to make a measurement.

***Guardrails*.** For all projects, only guardrails made from steel,
wood, and wire rope will be acceptable. All guardrail systems will
comply with the current OSHA standards. These guardrails will be placed
in the following areas if necessary or feasible based on job location or
requirements:

1\. On all open-sided floors.

2\. Around all open excavations or pits.

3\. On leading edges of roofs or mezzanines.

**Note**: Ceiling or floor covers, of sufficient strength and
construction, will be annotated with the word \"[hole]{.underline}\" and
placed over any ceiling or floor opening that poses a fall hazard.**\
\
Warning Line System\
\
**Warning lines may be appropriate for low sloped roofs where
individuals do not need to go all the way to the edge to perform their
tasks.

All construction work on a flat roof greater than 50 feet wide, which is
performed 6 feet or further back from the roof's edge, can be completed
by installing a warning line and using a safety monitor. If the roof is
flat and less than 50 feet wide, a competent person safety monitor may
be used.\
\
Warning lines will:

1\. Guard the entire perimeter of the roof where work is being
performed.

2\. Be erected 6 feet from the roof's edge.

3\. Consist of wire or nylon rope.

4\. Caution tape will be strung from post to post and must be able to
withstand 16 pounds of force.\
\
5. Be strung between stationary posts made of wood or metal.\
\
If an employee must access an area within 6 feet of the roof\'s edge,
for reasons other than exiting the roof via a ladder or fixed industrial
ladder, another employee must monitor that individual and warn him/her
of any dangers. If another employee is not available to act as a safety
monitor, then the employee must wear a full body harness, attached by a
fall restraint lanyard to an anchor point, to prevent reaching the
roof's edge.

**Personal Fall Protection Systems**

All employees, on any project that requires them to wear a personal fall
arrest or restraint system, will follow these guidelines:

1\. A full body harness will be used whenever there is the potential for
a fall from a height of 6 feet or more.

2\. Body belts may only be used to prevent a fall (for work
positioning), not as part of a fall arrest system.

3\. Only shock-absorbing lanyards or retractable lanyards are to be used
to keep impact forces at a minimum on the body.

4\. Only nylon rope or nylon straps with locking snap hooks are to be
used for restraint.

5\. All lanyards will have self-locking snap hooks.

6\. The employee will inspect all personal fall arrest equipment before
each use. Any equipment that has deteriorated or is bent, damaged, or
otherwise impacted will be removed from service and disposed of so that
it cannot be used again.

The maximum free-fall distance is not to exceed 6 feet. Consideration
must be given to the total fall distance. The following factors can
affect total fall distance:

1\. Length of connecting means (e.g., lanyard length, use of shock
absorbers, carabiners, snap hooks, etc.)

2\. Position and height of anchor points relative to work platform/area
(always keep above the head whenever possible).

3\. Position of attachment and D ring slide on the full body harness.

4\. Deployment of shock absorber (maximum 42 inches).

5\. Movement in the lifeline.

6\. Initial position of worker before free fall occurs (e.g., sitting,
standing, etc.).\
\
**Fall Protection Calculations**\
\
Typically the maximum free-fall distances are as follows: 6 feet for a
system with shock absorbers; 4 feet for a system without shock
absorbers; and 2 feet for a work positioning system. A basic formula to
calculate free fall is as follows:

**(HD-LL)-DAE=Free-Fall Distance**, where\
\
HD is the height from the working surface (platform) to the D ring;\
\
LL is the length of the lanyard; and\
\
DAE is the distance from the anchor point to the edge of the platform.

**Total Fall Distance**\
\
Total fall distance is the distance from the anchorage point to the D
ring when extended once the fall is arrested.

**Total Fall Distance =Free Fall Distance + Deceleration Distance**

By OSHA standards, the maximum free-fall distance is 6 feet, and the
maximum deceleration distance is 3-1/2 feet.\
\
**Clearance**

A basic formula to calculate the clearance is as follows:

**Length of Lanyard + Length of Deployed Shock Absorber + Height of the
D Ring + Safety Factor (2-3 feet)**.

The vertical distance from the anchor point to the next lower level must
exceed the clearance height or the worker will hit the surface.\
**\
Engineered Lifeline**\
\
1. Lifeline systems must be designed and approved by an engineer or
qualified person.

2\. Lifeline systems must be engineered to have appropriate anchor
points; line strength designed to hold the number of individuals
connected to it and to aid in the arrest of a fall; and durability in
order to hold a fallen employee(s) suspended until a rescue can
occur.**\
\
Inspection of Fall Protection Systems\
\
**The following criteria will be utilized to maintain all equipment in
good working condition:

1\. *Full Body Harnesses.*

A. Inspect before each use. Fall protection exhibiting any of these
faults shall be removed from service and destroyed.

\(1\) Closely examine all of the nylon webbing to ensure that there are
no burn marks which could weaken the material.

\(2\) Verify that there are no torn, frayed, or broken fibers; pulled
stitches; or frayed edges anywhere on the harness.

\(3\) Examine the D ring for excessive wear, discoloration, pits,
deterioration, or cracks.

\(4\) Verify that buckles are not deformed or cracked and operate
correctly.

\(5\) Check to see that each grommet (if present) is secure and not
deformed from abuse or a fall.

\(6\) The harness should never have additional punched holes.

\(7\) All rivets should be tight and not deformed.

\(8\) Check tongue/straps for excessive wear from repeated buckling.

B. A competent person will complete an annual inspection of all
harnesses and documentation will be maintained (see *Appendix 1*).
Harnesses will be hung and stored in an enclosed cabinet to protect from
damage.

C. All harnesses that are involved in a fall will be destroyed.

2\. *Lanyards/Shock-Absorbing Lanyards.*

A. Inspect before each use.

\(1\) Check lanyard material for cuts, burns, abrasions, kinks, knots,
broken stitches, and excessive wear.

\(2\) Inspect the snap hooks for distortions in the hook, locks, and
eye.

\(3\) Check carabiner for excessive wear, distortion, and lock
operation.

\(4\) Ensure that all locking mechanisms seat and lock properly.

\(5\) Once locked, locking mechanism should prevent hook from opening.

\(6\) Visually inspect shock absorber (if present) for any signs of
damage, paying close attention to where the shock absorber attaches to
the lanyard.

\(7\) Verify that points where the lanyard attaches to the snap hooks
are free of defects.

B. A competent person will complete an annual inspection of all lanyards
and documentation will be maintained (see *Appendix 2*). Lanyards will
be hung and stored in an enclosed cabinet to protect from damage.

C. All lanyards that are involved in a fall will be destroyed.

**Self-Retracting Lanyards/Lifelines**\
\
1. Inspect before each use.\
\
A. Visually inspect the body to ensure that there is no physical damage
to the body.

B. Make sure that all nuts and rivets are tight.

C. Make sure that the entire length of the nylon strap/wire rope is free
from cuts, burns, abrasions, kinks, knots, broken stitches/strands,
excessive wear, and retracts freely.

D. Test the unit by pulling sharply on the lanyard/ lifeline to verify
that the locking mechanism is operating correctly.

E. If the manufacturer requires, make certain that the retractable
lanyard is returned to the manufacturer for scheduled annual
inspections.

2\. A competent person will conduct a monthly inspection of all
self­-retracting lanyards/lifelines and documentation will be maintained
(see *Appendix 4).*

3\. Service per manufacturer specifications (1-2 years).

4\. Inspect for proper function after every fall.

**Snap Hooks and Carabiners**

1\. Inspect before each use.

A. Verify that there are no hook and eye distortions.

B. Verify that there are no cracks or pitted surfaces.

C. The keeper latch should not be bent, distorted, or obstructed.

D. Verify that the keeper latch seats into the nose without binding.

E. Verify that the keeper spring securely closes the keeper latch.

2\. Test the locking mechanism to verify that the keeper latch locks
properly.

3\. A competent person will complete an annual inspection of all snap
hooks and documentation will be maintained (see *Appendix 3*).

4\. All snap hooks involved in a fall will be destroyed.

**Tie-Off Adapters/Anchor Points\
\
**1. Inspect for integrity and attachment to solid surface.

2\. A competent person will complete an annual inspection of all tie­
offs and anchor points and documentation will be maintained.

3\. All tie offs and anchor points will be destroyed after a fall.

**\
Articulating Man Lift**\
\
1. Inspect before each use.

2\. Inspect/service per manufacturer guidelines. Forklift, scissors
lifts, and safety nets will be inspected at the beginning of each shift
in use. Structural integrity of the forklift basket will be checked per
the same schedule.

3\. A competent person will complete an annual inspection of the
forklift basket and documentation will be maintained.

**Horizontal Lifelines**

1\. Inspect for structural integrity of line and anchors before each
use.

2\. A competent person will complete an annual inspection.

**Guardrails**

1\. *Temporary systems*. A daily visual inspection will be completed by
a competent person.

2\. *Temporary systems*. A complete structural inspection will be
completed weekly by a competent person.

3\. *Permanent systems.* Annual structural inspections will be completed
by a competent person with future frequency of inspection based on
conditions/controls present.

**Storage and Maintenance of Fall Protection Equipment**\
\
A. Never store the personal fall arrest equipment in the bottom of a
toolbox, on the ground, or outdoors exposed to the elements (e.g., sun,
rain, snow, etc.).\
\
B. Hang equipment in a cool, dry location in a manner that retains its
shape.\
C. Always follow manufacturer recommendations for inspections.\
\
D. Clean with a mild, nonabrasive soap and hang to dry.\
\
E. Never force dry or use strong detergents in cleaning.

F. Never store equipment near excessive heat, chemicals, moisture, or
sunlight.

G. Never store in an area with exposures to fumes or corrosive elements.

H. Avoid dirt or other types of buildup on equipment.

I. Never use this equipment for any purpose other than personal fall
arrest.

J. Once exposed to a fall, remove equipment from service immediately.

**Fall Protection Training**

1\. Document the attendance of all trainees (see *Appendix 5*).

2\. All employees engaged in fall protection will be trained and have
the knowledge to:

A. Recognize the fall hazards associated with their job sites.

B. Understand the hazards associated with working near fall hazards.

C. Work safely in hazardous areas by utilizing appropriate fall
protection measures.

D. Understand and follow all components of this fall protection program.

E. Identify and understand the enforceable Department of
Commerce/Occupational Safety and Health Administration (OSHA) standards
and American National Standards Institute (ANSI) standards that pertain
to fall protection.

**Rescue Procedures/Methods**

In the unlikely event that a fall arrest occurs on site, personnel,
using an articulating man lift or ladders where feasible, will rescue
all employees. Alternate rescue would be through local emergency
services.

**Communication Issues**

In the event of a fall, the following people will be notified as soon as
possible.

1\. Rescue personnel (e.g., maintenance personnel).

2\. Manager or supervisor.

3\. Safety officer/coordinator.

4\. Fire department and emergency medical services, if necessary.

At the beginning of any work activity where fall protection is an issue,
rescue plans must be identified and discussed with all employees. The
*(insert the title{s} or name{s} of person)* will develop the rescue
plan(s).\
\
All employees involved in a fall arrest or fall will immediately be sent
for a medical evaluation to determine the extent of injuries, if any.

**Fall Investigation**

1\. All fall investigations will be conducted by *(insert the title{s}
or name{s} of person).\
*

2\. The following documentation will be completed as part of the fall
investigation:

A. Interviews with staff and witnesses.

B. Employee injury/accident report.

C. Supervisor injury/accident report.

**Fall Protection Program Evaluation**

This fall protection program will be evaluated periodically to determine
its effectiveness. The following criteria will be used to evaluate its
performance:

1\. Accident reports.

2\. Number of accidents.

3\. Management/staff compliance with program components.

4\. Periodic on-site audits.

5\. Staff feedback and interviews.

**Contractors Guidelines**

All outside contractors working in or on the premises of *(insert
name/location)* will be required to follow the guidelines set forth in
this fall protection program. Contractors in the post-award meeting will
be informed of these requirements as well as the on-site construction
rules that apply.

***Appendix 1***

**[Full Body Harness]{.underline}**

**[Annual Inspection Checklist]{.underline}**

Harness
Model/Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Serial
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Lot Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of
Manufacture:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Purchase: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+-----------------------------+--------------+------------------------+
| What to look for:           | Accep        | Comments               |
|                             | ted/Rejected |                        |
+-----------------------------+--------------+------------------------+
| Hardware: Includes D rings, | Accepted     |                        |
| buckles, keepers, and back  |              |                        |
| pads. Inspect for damage,   | Rejected     |                        |
| distortion, sharp edges,    |              |                        |
| burrs, cracks and corrosion |              |                        |
+-----------------------------+--------------+------------------------+
| Webbing: Inspect for cuts,  | Accepted     |                        |
| burns, tears, abrasions,    |              |                        |
| frays, excessive soiling,   | Rejected     |                        |
| and discoloration.          |              |                        |
+-----------------------------+--------------+------------------------+
| Stitching: Inspect for      | Accepted     |                        |
| pulled or cut stitches      |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Labels: Inspect, making     | Accepted     |                        |
| certain all labels are      |              |                        |
| securely held in place and  | Rejected     |                        |
| are legible.                |              |                        |
+-----------------------------+--------------+------------------------+
| Other:                      | Accepted     |                        |
|                             |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Others:                     | Accepted     |                        |
|                             |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Overall disposition:        | Accepted     | Inspected By:          |
|                             |              |                        |
|                             | Rejected     | Date Inspected:        |
+-----------------------------+--------------+------------------------+

***Appendix 2***

**[Lanyards]{.underline}**

**[Annual Inspection Checklist]{.underline}**

Lanyard
Model/Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Serial
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Lot Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of
Manufacture:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Purchase: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+-----------------------------+--------------+------------------------+
| What to look for:           | Accep        | Comments               |
|                             | ted/Rejected |                        |
+-----------------------------+--------------+------------------------+
| Hardware: Includes snap     | Accepted     |                        |
| hooks, carabiners,          |              |                        |
| adjusters, keepers,         | Rejected     |                        |
| thimbles, and D rings.      |              |                        |
| Inspect for damage,         |              |                        |
| distortion, sharp edges,    |              |                        |
| burrs, cracks, corrosion    |              |                        |
| and proper operation.       |              |                        |
+-----------------------------+--------------+------------------------+
| Webbing: Inspect for cuts,  | Accepted     |                        |
| burns,                      |              |                        |
|                             | Rejected     |                        |
| tears, abrasions, frays,    |              |                        |
| excessive soiling, and      |              |                        |
| discoloration.              |              |                        |
+-----------------------------+--------------+------------------------+
| Stitching: Inspect for      | Accepted     |                        |
| pulled or cut stitches.     |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Synthetic Rope: Inspect for | Accepted     |                        |
| pulled or cut yarns, burns, |              |                        |
| abrasions, knots, excessive | Rejected     |                        |
| soiling, and discoloration. |              |                        |
+-----------------------------+--------------+------------------------+
| Energy Absorbing Component: | Accepted     |                        |
| Inspect                     |              |                        |
|                             | Rejected     |                        |
| for elongation, tears and   |              |                        |
| excessive                   |              |                        |
|                             |              |                        |
| soiling.                    |              |                        |
+-----------------------------+--------------+------------------------+
| Labels: Inspect, making     | Accepted     |                        |
| certain all labels are      |              |                        |
| securely held in place and  | Rejected     |                        |
| are legible.                |              |                        |
+-----------------------------+--------------+------------------------+
| Overall disposition:        | Accepted     | Inspected By:          |
|                             |              |                        |
|                             | Rejected     | Date Inspected:        |
+-----------------------------+--------------+------------------------+

***Appendix 3***

**[Snap Hooks and Carabiners\
Annual Inspection Checklist]{.underline}**

Hook/Carabiner
Model/Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Serial
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Lot Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of
Manufacture:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Purchase:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+-----------------------------+--------------+------------------------+
| What to look for:           | Accep        | Comments               |
|                             | ted/Rejected |                        |
+-----------------------------+--------------+------------------------+
| Physical Damage: Inspect    | Accepted     |                        |
| for cracks, sharp edges,    |              |                        |
| burrs, deformities and      | Rejected     |                        |
| locking operations          |              |                        |
+-----------------------------+--------------+------------------------+
| Excessive Corrosion:        | Accepted     |                        |
| Inspect for corrosion,      |              |                        |
| which affects the operation | Rejected     |                        |
| and/or the strength.        |              |                        |
+-----------------------------+--------------+------------------------+
| Markings: Inspect and make  | Accepted     |                        |
| certain marking(s) are      |              |                        |
| legible.                    | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Other:                      | Accepted     |                        |
|                             |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Other:                      | Accepted     |                        |
|                             |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Other:                      | Accepted     |                        |
|                             |              |                        |
|                             | Rejected     |                        |
+-----------------------------+--------------+------------------------+
| Overall disposition:        | Accepted     | Inspected By:          |
|                             |              |                        |
|                             | Rejected     | Date Inspected:        |
+-----------------------------+--------------+------------------------+

***Appendix 4***

**[Self-Retracting Lanyard/Lifeline]{.underline}**

**[Annual Inspection Checklist]{.underline}**

Self-retracting Lanyard/Lifeline
Model/Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Serial
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Lot
Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Manufacture:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date of
Purchase:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+-----------------------+-----------------------+-----------------------+
| Inspection Items      | Accepted/Rejected     | Comments              |
+-----------------------+-----------------------+-----------------------+
| Impact Indicator:     | Accepted              |                       |
| Inspect indicator for |                       |                       |
| activation (rupture   | Rejected              |                       |
| of red stitch,        |                       |                       |
| elongated indicator,  |                       |                       |
| etc.).                |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Screws/Fasteners:     | Accepted              |                       |
| Inspect for damage    |                       |                       |
| and make sure all     | Rejected              |                       |
| screws and fasteners  |                       |                       |
| are tight.            |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Housing: Inspect for  | Accepted              |                       |
| distortion, cracks    |                       |                       |
| and other damage.     | Rejected              |                       |
| Inspect anchoring     |                       |                       |
| loop for distortion   |                       |                       |
| or damage.            |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Lanyard/Lifeline:     | Accepted              |                       |
| Inspect for cuts,     |                       |                       |
| burns, tears,         | Rejected              |                       |
| abrasion, frays,      |                       |                       |
| excessive soiling and |                       |                       |
| discoloration.        |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Locking Action:       | Accepted              |                       |
| Inspect for proper    |                       |                       |
| breaking action.      | Rejected              |                       |
+-----------------------+-----------------------+-----------------------+
| Retraction/Extension: | Accepted              |                       |
| Inspect spring        |                       |                       |
| tension by pulling    | Rejected              |                       |
| lanyard out fully and |                       |                       |
| allowing to retract   |                       |                       |
| fully (lifeline must  |                       |                       |
| be taut with no       |                       |                       |
| slack).               |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Hooks/Carabiners:     | Accepted              |                       |
| Inspect for physical  |                       |                       |
| damage, corrosion,    | Rejected              |                       |
| proper orientation    |                       |                       |
| and markings.         |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Labels: Inspect,      | Accepted              |                       |
| making certain all    |                       |                       |
| labels are securely   | Rejected              |                       |
| held in place and     |                       |                       |
| legible.              |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Overall disposition:  | Accepted              | Inspected by:         |
|                       |                       |                       |
|                       | Rejected              | Date Inspected        |
+-----------------------+-----------------------+-----------------------+

***Appendix 5***

**[Fall Protection Safety Training Record]{.underline}**

Training
Topic:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Instructors
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of
Training:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ----------------------------------- -----------------------------------
  Employee Name                       Cost Center Name/Location

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      

                                      
  ----------------------------------- -----------------------------------