Ladder Safety Method Statement Form
Complete this form to record the ladder work details, planned method, safety checks, and acknowledgment before the task begins.
Work Details
Site / Location
*
Work / Activity Description
*
Date of Work
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Start Time
Hour Minutes
AM
PM
AM/PM Option
Personnel and Ladder Plan
Responsible Person / Supervisor Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Ladder Type to Be Used
*
Step Ladder
Extension Ladder
Platform Ladder
Telescopic Ladder
Other
Working Height / Access Requirement (m)
Safety Checks and Acknowledgment
Pre-use safety checks
*
Acknowledgment
*
I confirm the method statement and safety controls will be followed before work begins.
Other
Submit
Should be Empty: