Title Page
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Conducted on:
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Prepared by:
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Ladder #:
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Step or Extension Ladder:
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Brand:
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Type:
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Size:
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Steps: Loose, Cracked, Bent, or Missing
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Rails: Cracked, Bent, Split, or Frayed Rail Shields
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Rungs: Loose, Cracked, Bent, or Missing
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Rung Locks: Loose, Bent, Missing, or Broken
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Pail Shelf: Loose, Bent, Missing, or Broken
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Top: Cracked, Loose, or Missing
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Spreader: Loose, Bent, or Broken
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Rope/Pulley: Loose, Bent or Broken
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Shoes: Worn, Broken, or Missing
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Hardware: Missing, Loose, or Broken
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Labels: Missing or Not Readable
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General: Rust, Corrosion, Loose
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Other: Bracing or Rivets
Corrective Action
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Ladder tagged as damaged & removed from use.
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Ladder is in good condition.
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Sign: