Title Page
-
Employee Name
-
Instructor's Name
-
Select date
Equipment Check
-
Does the employee have all the proper personal equipment?
-
Is it in proper working order and being worn properly?
Site Survey
-
Has the employee inspected the job-site?
Pole Inspection
-
Has the employee properly inspected the pole(s)?
Ladder Inspection
-
Has the employee properly inspected the ladder?
Ladder Removal
-
Has the employee sufficiently mastered a safe technique?
Ladder Carries
-
Horizontal method(s)- properly demonstrated?
-
Vertical method(s)- properly demonstrated?
Ladder Placement
-
Has the ladder been properly placed at the site?
Extending The Ladder
-
Has the ladder extension been performed safely and properly?
Ascending The Ladder
-
Has ascending been performed safely and properly?
Securing The Climber
-
Belt-on- properly demonstrated?
-
Belt-off- properly demonstrated?
Descending The Ladder
-
Has descending been performed safely and properly?
Contracting The Ladder
-
Has the ladder contraction been performed safely and properly?
Ladder Replacement (Re-racking and Securing)
-
Has the employee sufficiently mastered a safe technique?
Final Score
-
Pass/Fail?
-
Instructor Signature
-
Employee's Signature
