CFMHS 24 - LADDER INSPECTION FORM Rev 4.0 Jan 16

• Technician

• DATE OF INSPECTION

  Date

• Ladder manufacturers name

• LADDER ID

• TYPE OF LADDER

  LADDER

  STEP-LADDER

  HOP UP

  OTHER

• LADDER MATERIAL

  METAL

  WOODEN

  FIBRE GLASS

  OTHER

• Date of purchase

INSPECTIONS

• ARE THE TREADS/RUNGS IN GOOD CONDITION

  YES

  NO

  N/A

• ARE THE TREADS/RUNGS FREE FROM DEFECTS SUCH AS HOLES, CRACKS, ETC

  YES

  NO

  N/A

• ARE THE TREADS/RUNGS FREE FROM GREASE, PAINT, MUD OR OTHER SUBSTANCES

  YES

  NO

  N/A

• ARE THE TREADS/RUNGS SECURED TO THE STILES

  YES

  NO

  N/A

• DOES THE LADDER STAND FIRMLY & EVENLY

  YES

  NO

  N/A

• ARE ROPES AND CORDS IN GOOD CONDITION WITHOUT DAMAGE

  YES

  NO

  N/A

• ARE RIVETS, AND OTHER FITTINGS IN GOOD CONDITION WITHOUT CORROSION

  YES

  NO

  N/A

• ARE PULLEYS AND HINGES IN GOOD CONDITION WITHOUT DAMAGE

  YES

  NO

  N/A

• IS THERE ANY MOVEMENT IN THE TREADS/RUNGS

  YES

  NO

  N/A

• ARE THE TIE RODS SECURED (WOODEN LADDER ONLY)

  YES

  NO

  N/A

• ARE ANY TREADS/RUNGS MISSING

  YES

  NO

  N/A

• ARE THE TREADS/RUNGS WARPED, DISTORTED OR BENT

  YES

  NO

  N/A

• IS THE LADDER PAINTED OR OTHERWISE TREATED WHICH MAY HIDE DEFECTS

  YES

  NO

  N/A

• ARE THE STILES WORN OR DAMAGED AT THE TOP OR BOTTOM

  YES

  NO

  N/A

• IS THE LADDER IN A SUITABLE CONDITION FOR USE<br>IF NO NOTE THE NAME OF RESPONSIBLE PERSON NOTIFIED

  YES

  NO

  N/A

• INSPECTED BY

  Sign

• DATE

  Date

• NAME OF RESPONSIBLE PERSON NOTIFIED OF DEFECTS

• ADDITIONAL COMMENTS