Ladder Inspection Form
Inspection Date
-
Month
-
Day
Year
Date
Company Name
Contact Person Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Ladder
Single Pole Ladders
Extension Ladders
Step Ladders
Dual Purpose Ladders
Platform Ladders.
Other
Checklist
Yes
No
Not Present
Remarks
Is there structural damage?
1
2
3
Are there missing safety devices or broken rungs or steps?
4
5
6
Is there grease, dirt, or other substances that could cause slips or falls?
7
8
9
Is there paint, tape, stickers, or an opaque covering that could hide defects?
10
11
12
Is the ladder painted or coated with any opaque covering, except for identification or warning labels?
13
14
15
Will any of the ladder’s components will cause punctures, lacerations, or snag the user’s clothing?
16
17
18
Is this the correct ladder for the task?
19
20
21
Is the ladder on a stable and level surface?
22
23
24
If using an extension ladder, are you able to use the 4-1 rule?
25
26
27
Does the ladder’s length allow you to safely reach the work area?
28
29
30
Will your weight plus the weight of tools/supplies require you to load ladder beyond the maximum intended load or rated capacity?
31
32
33
Are your performing electrical work or near overhead power lines?
34
35
36
Are the areas around the top and bottom of the ladder clear?
37
38
39
Can you do your job without using the top step of a ladder?
40
41
42
Are you able to hoist the tools you need up and down from the work surface?
43
44
45
When climbing, face the ladder and use the hand-over-hand method, placing your hands on the rungs.
46
47
48
When using a stepladder, do not climb using the cross-bracing on the back of the ladder.
49
50
51
Do not tie or fasten ladders together to create longer sections.
52
53
54
Ensure a metal spreader or locking device is on each stepladder to hold the front and back sections open when the ladder is being used.
55
56
57
Do not move or change the ladder's position while you are on it or allow anyone else to do so.
58
59
60
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Inspector Name
First Name
Last Name
Inspector Phone Number
Inspector Signature
Date Signed
-
Month
-
Day
Year
Date
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