Ladder Inspection Form Company Name: Ladder Reference Number: Inspector Please Print Dept. Stepladder Size ft. ❑ Extension Ladder Size ft. ❑ ❑ Fiberglass ❑ Aluminum ❑ Wood ❑ Fiberglass ❑ Aluminum Steps: Loose, Cracked, Bent or Missing ❑ ❑ Rails: Cracked, Bent, Split or Frayed Rail Shields ❑ ❑ Labels: Missing or Not Readable ❑ ❑ Pail Shelf: Loose, Bent, Missing or Broken ❑ ❑ Top: Cracked, Loose or Missing ❑ ❑ Spreader: Loose, Bent or Broken ❑ ❑ General: Rust, Corrosion or Loose ❑ ❑ Other: Bracing, Shoes, Rivets ❑ ❑ Rungs: Loose, Cracked, Bent or Missing ❑ ❑ Rails: Cracked, Bent, Split or Frayed ❑ ❑ Labels: Missing or Not Readable ❑ ❑ Rung Locks: Loose, Bent, Missing or Broken ❑ ❑ Hardware: Missing, Loose or Broken ❑ ❑ Shoes: Worn, Broken or Missing ❑ ❑ Rope/Pulley: Loose, Bent or Broken ❑ ❑ Other: Bracing Rivets ❑ ❑ General: Rust, Corrosion or Loose ❑ ❑ Yes No Yes No Circle Areas of Damage Circle Areas of Damage Actions: ❑ Ladder tagged as damaged & removed from use ❑ Ladder is in good condition Actions: ❑ Ladder tagged as damaged & removed from use ❑ Ladder is in good condition Date. Provided by Werner Co.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Ladder Inspection FormCompany Name:
Ladder Reference Number:
Inspector
Please Print
Dept.
Stepladder Size ft.q
Extension Ladder Size ft.q
q Fiberglass q Aluminum q Wood
q Fiberglass q Aluminum
Steps: Loose, Cracked, Bent or Missing q qRails: Cracked, Bent, Split or Frayed
Rail Shields q qLabels: Missing or Not Readable q qPail Shelf: Loose, Bent, Missing or Broken q qTop: Cracked, Loose or Missing q qSpreader: Loose, Bent or Broken q qGeneral: Rust, Corrosion or Loose q qOther: Bracing, Shoes, Rivets q q
Rungs: Loose, Cracked, Bent or Missing q qRails: Cracked, Bent, Split or Frayed q qLabels: Missing or Not Readable q qRung Locks: Loose, Bent, Missing or Broken q qHardware: Missing, Loose or Broken q qShoes: Worn, Broken or Missing q qRope/Pulley: Loose, Bent or Broken q qOther: Bracing Rivets q qGeneral: Rust, Corrosion or Loose q q
Yes No
Yes No
Circle Areasof Damage
Circle Areasof Damage
Actions: q Ladder tagged as damaged & removed from use
q Ladder is in good condition
Actions: q Ladder tagged as damaged & removed from use
q Ladder is in good condition
Date.
Provided by Werner Co.
Actions: q Ladder tagged as damaged & removed from use
q Ladder is in good condition
®
®
Specialty Ladderqq Fiberglass q Aluminum q Wood
Steps/Rungs: Loose, Cracked Bent or Missing q q
Rails: Cracked, Bent, Split or Frayed q q
Labels: Missing or Not Readable q q
Hardware: Missing, Loose or Broken q q
Fasteners: Rust, Corrosion, Loose or Missing q q
Top: Cracked, Loose, or Missing q q
Spreader: Loose, Bent or Broken q qOutriggers: Missing, Rust, Corrosion or Loose
for scaffolding q q
General: Rust, Corrosion or Loose q q
Hinges: Loose, Bent or Missing q q
Locks: Loose, Bent, Broken or Missing q qBracingFront,Rear: Loose, Bent, Broken or Missing q q
Rivets: Rust, Corrosion, Loose, Missing q q
Shoes: Worn, Broken or Missing q q
Platform: Loose, Bent, Broken or Missing q q
Rail Shield: Missing or Loose q q
Shoulder Bolt: Rust, Corrosion or Loose q qCasters: Rust, Corrosion or Loose
for scaffolding q q
Yes No
Model Number:
Mark all that apply
GM6407 © 2004 Werner Co.Printed in U.S.A. August 2004
Ladder Inspection Form Provided by Werner Co.
Related Documents
![SAFETY WALKAROUND CHECKLIST PORTABLE LADDERS · D Portable ladders are placed 1 ft from the wall for every 4 ft of ladder length (75° pitch). [29 CFR 1926.1053(b)(5)(i)] WORK PRACTICES](https://static.cupdf.com/doc/110x72/5f7020c12f22254ef61ea202/safety-walkaround-checklist-portable-ladders-d-portable-ladders-are-placed-1-ft.jpg)
