Ladder Inspection Form

Company Name:
Please Print

Provided by Werner Co.

Ladder Reference Number: Inspector

Dept. Date.
Size ft.

Stepladder

Fiberglass

Aluminum Steps: Rails: Labels:

Wood Loose, Cracked, Bent or Missing Cracked, Bent, Split or Frayed Rail Shields Missing or Not Readable Loose, Bent, Missing or Broken Cracked, Loose or Missing Loose, Bent or Broken Rust, Corrosion or Loose Bracing, Shoes, Rivets

Yes

No

Pail Shelf: Top: Spreader: General:

Circle Areas of Damage

Other:

Actions:

Ladder tagged as damaged & removed from use Ladder is in good condition

Extension Ladder

Size Aluminum Rungs: Rails: Labels: Hardware: Shoes: Other: General:

ft.

Fiberglass

Yes
Loose, Cracked, Bent or Missing Cracked, Bent, Split or Frayed Missing or Not Readable Missing, Loose or Broken Worn, Broken or Missing Bracing Rivets Rust, Corrosion or Loose

No

Rung Locks: Loose, Bent, Missing or Broken

Rope/Pulley: Loose, Bent or Broken

Circle Areas of Damage

Actions:

Ladder tagged as damaged & removed from use Ladder is in good condition

Ladder Inspection Form

Provided by Werner Co.

Specialty Ladder

Fiberglass

Aluminum

Wood

Model Number:

Mark all that apply

Steps/Rungs: Rails: Labels: Hardware: Fasteners: Top: Spreader: Outriggers: General: Hinges: Locks: Bracing Front,Rear: Rivets: Shoes: Platform: Rail Shield: Shoulder Bolt: Casters:

Yes

No

Loose, Cracked Bent or Missing Cracked, Bent, Split or Frayed Missing or Not Readable Missing, Loose or Broken Rust, Corrosion, Loose or Missing Cracked, Loose, or Missing Loose, Bent or Broken Missing, Rust, Corrosion or Loose for scaffolding Rust, Corrosion or Loose Loose, Bent or Missing Loose, Bent, Broken or Missing Loose, Bent, Broken or Missing Rust, Corrosion, Loose, Missing Worn, Broken or Missing Loose, Bent, Broken or Missing Missing or Loose Rust, Corrosion or Loose Rust, Corrosion or Loose for scaffolding

Actions:
GM6407 2004 Werner Co. Printed in U.S.A. August 2004

Ladder tagged as damaged & removed from use Ladder is in good condition