Lab Safety Supply - Custom Harness Form

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*	Required Fields
*	CONTACT PERSON:		YOUR LSS ACCT #:
*	HARNESS USER'S NAME:	*	CONTACT PHONE #:
		*	CONTACT EMAIL:

* 1.) APPLICATION:
* 2.) HARNESS # Select from Harness Style Checklist Below

Note: The harness made to the below specifications is a Custom Harness and is non-returnable.

All information beside the shaded areas must be filled out for order to be processed.
Bacou-Dalloz/Miller Fall Protection reserves the right to refuse any custom fit harness order based on size/weight discrepancies. 4X is the largest size that will be manufactured.

A 400 lbs. maximum capacity rating applies to Custom Fit Miller Harnesses, excluding Titan. For employees having a combined body & tool weight greater than 310 lbs, the employer must modify the fall protection system to provide proper protection for such heavier weights.

Please choose the style of the harness — Combined weight of user plus tools and equipment

350 lb. Capacity Harnesses

	Adjustable fit harness with permanently attached six-foot nylon web lanyard and integral Sofstop shock absorber (8428-47).
	Versalite harness with permanently attached six-foot nylon web lanyard, integral Sofstop shock absorber, side positioning dee rings, and belt (650-73).
	Versalite harness with permanently attached six-foot nylon web lanyard, integral Sofstop shock absorber, tongue buckle legs, and belt (650-72).
	Adjustable fit harness with permanently attached six-foot Manyard shock absorbing lanyard (8428-59).
	Versalite harness with permanently attached six-foot Manyard shock absorbing lanyard, side positioning dee rings, and belt (650-75).
400 lb. Capacity Harnesses
	Sub pelvic harness with permanently attached six-foot nylon web lanyard and integral Sofstop shock absorber (8095-47).
	Sub pelvic harness with permanently attached six-foot nylon web lanyard, integral Sofstop shock absorber and side positioning dee rings (8095-52).
	Sub pelvic harness with permanently attached six-foot nylon web lanyard, integral Sofstop shock absorber and 14 grommets in each leg strap. (8095-71).
	Duraflex harness with permanently attached six-foot nylon web lanyard, integral Sofstop shock absorber, tongue buckle legs, and belt (E650-72).
	Duraflex harness with permanently attached six-foot nylon web lanyard, integral Sofstop shock absorber, side positioning dee rings, tongue buckle legs and belt (E650-82).
	Duralite lightweight harness with permanently attached six-foot nylon web lanyard and integral Sofstop shock absorber (552-47).
	Sub pelvic harness with permanently attached six-foot Manyard shock absorbing lanyard (8095-59).
	Duraflex harness with permanently attached six foot Manyard shock absorbing lanyard and belt (E8759-80).
	Duraflex Harness with permanently attached six-foot Manyard shock absorbing lanyard, side positioning dee rings, 14 grommets in leg strap and belt (E650-83).
	Duraflex harness with permanently attached six-foot Manyard shock absorbing lanyard, 14 grommets in leg straps and belt (E650-81)


3.) INDIVIDUAL MEASUREMENTS (measure over clothing)
*	WEIGHT (INCLUDE TOOLS): (Max. weight 400 lbs.)


*	HEIGHT:


*	CHEST: (Max. chest measurement 62")

*	ABDOMEN/WAIST: (Max. waist measurement 60")

*	THIGH: (Max. thigh measurement 34")

*	WAIST TO SHOULDER: (Top of shoulder to waist, over chest & abdomen--Max. 28")