POWER CLEANING SERVICES & BUILDING MAINTENANCE

LADDER SAFETY INSPECTION FORM- HSEQ DIVISION

Date of Inspection: Name of Supervisor: Ladder Identification: Type of Ladder: ( ) Extension ( ) Step Construction of Ladder: ( ) Wood ( ) Metal ( ) Fiberglass General Name of Inspector: Site:

Condition OK

Needs Repair

Not Applicable

Loose steps or rungs (loose if can be moved by hand) Loose nails, screws, bolts, or other materials Cracked, split, or broken uprights, braces, steps, or rungs Slivers on uprights, rungs, or steps Rungs/steps missing Rungs/steps on metal ladders corrugated or knurled Contamination of the rungs or treads with grease, oil or chemicals, or slippery materials Wooden parts free from splinters, cracks, decay Joints between rungs and side rails tight (loose if can be moved by hand) Movable parts operate freely Damaged or worn non-slip bases Rails free from cracks/splitting Loose nails/screws Condition of rope if any to be used with the ladder Stepladders Wobbly Do not exceed 20 feet in length Loose or bent hinge spreaders Broken stop on hinge spreaders Sharp edges on spreaders Loose hinges Extension Ladders Loose, broken, or missing extension locks Defective locks that do not seat properly when ladder is extended Frayed or worn rope Single section ladders do not exceed 30 feet in length Two-section extension ladders do not exceed 48 feet in length for metal ladders and 60 feet in length for wood ladders Ladders with more than two sections do not exceed 60 feet in length Other Comments Circle Areas of Damages Step Ladders Wood Metal

Fibre Glass

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POWER CLEANING SERVICES & BUILDING MAINTENANCE

LADDER SAFETY INSPECTION FORM- HSEQ DIVISION
Circle Areas of Damages Extension Ladders Wood Metal Fibre Glass

Actions Ladder tagged as damaged & removed from use Ladder is in good condition HSE Officer Site Supervisor

Yes

No

If Repaired Date of Repair : Date Returned:

Client Representative

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