Title Page
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Operative Name
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Conducted on
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Inspected by
Extension Ladder
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Does the operative have an Extension Ladder?
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Material
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Rungs - Loose, Cracked, Bent or Missing
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Rails - Cracked, Bent, Split or Frayed
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Label - Missing / Not Readable
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Rung Lock - Loose, Bent, Missing or Broken
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Shoes - Worn, Broken or Missing
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Rope or Pully - Loose, Bent or Broken
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General - Rust or Corrosion
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Other - Bracing & Rivets
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Inspection Overview
Stepladder
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Does the operative have a stepladder?
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Material
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Steps - Loose, Cracked, Bent or Missing
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Rails - Cracked, Bent, Split or Frayed
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Top - Loose, Cracked, Bent or Missing
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Label - Missing / Not Readable
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Shoes - Worn, Broken or Missing
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General - Rust or Corrosion
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Other - Bracing & Rivets
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Inspection Overview
Hop Up
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Does the operative have a hop up?
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Material
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Steps - Loose, Cracked, Bent or Missing
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Working Platform - Loose, Cracked, Bent or Missing
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Label - Missing / Not Readable
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Shoes - Worn, Broken or Missing
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General - Rust or Corrosion
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Other - Bracing & Rivets
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Inspection Overview
