<title>2026-09-01_CanwideSteel_SRLInspection

INSPECTION SRL

OHS PROGRAM – SELF-RETRACTING LIFELINE INSPECTION

FORM #: 11-09 | Created: June 2025 | Rev. 1.5 | Page 1 of 2 & 2 of 2

Company Name *

Date (DD/MM/YYYY) *

Project *

Address *

Contact Person *

Cell # *

Make *

Model & Length *

Serial / Lot Number *

Employer ID # (If Applicable)

Mfg. Date *

Recert. Date & Status *

VALID DUE

Fall Arrest Indicator

Does it have a fall arrest indicator?

Yes No Don't know

Is it deployed?

Yes No N/A

Is it damaged?

Yes No N/A

Comments: Please include details on findings above when applicable

Manufacturer Label

CSA/ANSI Approval visible and properly phrased

Yes No

Missing

Yes No

Legible

Yes No

Recertification due

Yes No NA (Type 1)

Comments: Please include details on findings above when applicable

Operation

Retracts smoothly

Yes No

Brakes normally

Yes No

Hooks operating

Yes No

Comments: Please include details on findings above when applicable

Housing and Hardware

Bends

Yes No

Cracks

Yes No

Distorted

Yes No

Broken

Yes No

Worn

Yes No

Rust

Yes No

Comments: Please include details on findings above when applicable

Webbing Lifeline N/A (Not Applicable)

Cuts

Yes No

Tears

Yes No

Holes

Yes No

Frays

Yes No

Abrasions

Yes No

Grease

Yes No

Paint

Yes No

Discoloration

Yes No

Chemical damage

Yes No

Missing stitches

Yes No

Pulled/cut stitches

Yes No

Odor

Yes No

Uneven width

Yes No

Undue stretching

Yes No

Hard or shiny spots

Yes No

Writing

Yes No

Modification

Yes No

Mold/mildew

Yes No

Stains

Yes No

Knots

Yes No

Comments: Please include details on findings above when applicable

Wire Rope / Cable N/A (Not Applicable)

Paint

Yes No

Rust

Yes No

Cracks

Yes No

Nicks

Yes No

Welds

Yes No

Bent

Yes No

Distorted

Yes No

Sharp Edges

Yes No

Bird Caging

Yes No

Broken Wires

Yes No

Crushed/flattened

Yes No

Uneven diameter

Yes No

Comments: Please include details on findings above when applicable

Decision Flow

Start Inspection

Does it have a fall arrest indicator?

NO ↓ Don't know → Stop & check mfg

Is it damaged or deployed?

NO ↓ YES → FAIL

Is label available & legible?

YES ↓ NO → FAIL

With CSA/ANSI approval?

YES ↓ NO → FAIL

Recert. Date valid?

YES / NA ↓ NO → FAIL

A

Operation questions ALL YES?

YES ↓ NO → FAIL

All Housing questions NO?

YES ↓ NO → Check mfg

All Webbing questions NO?

YES / NA ↓ NO → Check mfg

All Wire questions NO?

YES / NA ↓ NO → Check mfg

✓ PASS

Inspection Outcome *

PASS FAIL

Outcome Comments / Defect Details

Inspected By *

Signature

Sign here / Select Inspector

Date *

⚠️ Equipment failing inspection must be immediately removed from service, tagged "DO NOT USE", and reported to safety supervisor.

PHOTOS / ATTACHMENTS

ADD PHOTO / CAPTURE IMAGE

OHS PROGRAM – INSPECTION SRL | Form #: 11-09 | Rev. 1.5 | Canwide Steel Ltd.