Title Page

  • Conducted on:

  • Prepared by:

  • Ladder #:

  • Step or Extension Ladder:

  • Brand:

  • Type:

  • Size:

  • Steps: Loose, Cracked, Bent, or Missing

  • Rails: Cracked, Bent, Split, or Frayed Rail Shields

  • Rungs: Loose, Cracked, Bent, or Missing

  • Rung Locks: Loose, Bent, Missing, or Broken

  • Pail Shelf: Loose, Bent, Missing, or Broken

  • Top: Cracked, Loose, or Missing

  • Spreader: Loose, Bent, or Broken

  • Rope/Pulley: Loose, Bent or Broken

  • Shoes: Worn, Broken, or Missing

  • Hardware: Missing, Loose, or Broken

  • Labels: Missing or Not Readable

  • General: Rust, Corrosion, Loose

  • Other: Bracing or Rivets

Corrective Action

  • Ladder tagged as damaged & removed from use.

  • Ladder is in good condition.

  • Sign:

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