Title Page
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New Hire/Technicians Name
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Type of Safety Course
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Conducted on
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Prepared by
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Office Location that the Safety Training Occured
Section A - Were Safety Procedures followed Satisfactorily?
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Was a hard hat worn while working with the ladder?
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Was the Ladder properly inspected before use to confirm it is in good working condition?
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Did the individual verify that the soles of his/her boots were clean to maximize traction to avoid slipping?
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Was the 3 Points-of-Contact method properly used when climbing the ladder?
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Did the individual face the ladder when moving up and down it?
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Was the Ladder Properly setup? 75 Degree angle?
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Before climbing did the technician check the ladder's stability?
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Did the technician extend the ladder 3 rungs above the point of support (rooftop)?
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Was the ladder properly tied down to prevent any movement?
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Did the technician properly inspect the roofs surface before climbing onto the roof?
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Does the individual clearly understand that the Little Giant Type ladder can only be used in step ladder configuration - can not be extended out?
Section B - Does the New Hire/Technician demonstrate the ability to properly use a Ladder for his/her job duties?
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Can the individual remove the ladder from the ladder rack on the vehicle then place it back onto the vehicle?
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Can the individual handle (carry) the ladder during transport to the work area?
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Can the individual safely/effectively set the ladder up into proper position at the work area?
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Can the individual safely and successfully climb onto the rooftop from the ladder?
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Does the individual exhibit any fear of heights or express to you his/her possible fear of heights?
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Comments:
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New Hire/Technicians Signature
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Training Team Member/FOS Signature
