Ladder Safety Assessment Questionnaire Form
Ladder Safety Assessment Questionnaire Form. Please complete this assessment to help us evaluate and improve ladder safety practices.
Have you received formal training on ladder safety?
*
Yes
No
How often do you inspect ladders before use?
*
Always
Sometimes
Rarely
Never
Rate your confidence in using ladders safely.
*
1
2
3
4
5
Please indicate your agreement with the following ladder safety statements.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I always maintain three points of contact.
1
2
3
4
5
I never use damaged or defective ladders.
6
7
8
9
10
I set up ladders on stable, level surfaces.
11
12
13
14
15
I avoid carrying tools while climbing.
16
17
18
19
20
I am aware of the maximum load capacity.
21
22
23
24
25
What type of ladder do you use most often?
*
Please Select
Step ladder
Extension ladder
Platform ladder
Multi-purpose ladder
Other
How frequently do you encounter unsafe ladder conditions (e.g., loose rungs, missing feet, damaged rails)?
*
Never
Rarely
Sometimes
Often
Do you report unsafe ladder conditions when you notice them?
*
Always
Sometimes
Never
Which environments do you most frequently use ladders in?
*
Indoors
Outdoors
Wet/slippery areas
Uneven surfaces
Other
Have you ever experienced or witnessed a ladder-related incident?
*
Yes
No
Please provide any additional comments or suggestions for improving ladder safety.
Submit Assessment
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