Ladder Set Up and Usage Checklist

• Client / Site

• Conducted on

  Date
• Location
  Address

• Prepared by

General Information

• Nature of work

• Describe the job task where ladder is used

• List the names of the workers using the ladder

• Take a photo of the ladder

  Media

• Type of Ladder

Ladder Set Up

• Take photo of the surrounding area

  Media

• Location is safe with no uneven surfaces

  Yes

  No

  N/A

• Weather is good (Not windy or stormy)

  Yes

  No

  N/A

• No electrical hazards present

  Yes

  No

  N/A

• Has used a firm level footing

  Yes

  No

  N/A

• Base is 1 ft away from the wall for every 4 ft. in height setting up a 75 degree angle

  Yes

  No

  N/A

• Base of ladder is braced or tied up

  Yes

  No

  N/A

• Top ladder is secured

  Yes

  No

  N/A

• Area was clear from obstructions and hazards

  Yes

  No

  N/A

Ladder Climbing

• Prior to using of ladder, does the personnel undergo proper training?

  Yes

  No

  N/A

• Is the personnel wearing proper and quality protective equipment?

  Yes

  No

  N/A

• List the PPE used

• Facing the ladder when climbing up or down and is on the center

  Yes

  No

  N/A

• Using 3-point contact

  Yes

  No

  N/A

• Carrying no loads

  Yes

  No

  N/A

• Observing "One person at a time" rule

  Yes

  No

  N/A

• Not doing unnecessary movements

  Yes

  No

  N/A

• Not sitting on top of ladder

  Yes

  No

  N/A

Recommendations

• Please write here

Completion

• I confirm and acknowledge the recommendations and safety measures provided for better ladder safety. Full Name and Signature of Employee

  Sign

• Full Name and Signature of the Inspector

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