RAJASTHAN NORTHERN AREA DEVELOPMENT PROJECT

MONTHLY LADDER INSPECTION RECORD

Project: Job Number: Inspector:

Contractor: Color Code: Inspection Month:

√ = OK N/A = Not Applicable D = Defect

General
Type of Ladder ID Number Side Rail Rungs Spreader Limiting
Hinge / Fittings Rear Support Leg Tie off Rope Reinforcement
Device

Type of Ladder: Step Ladder, Single Ladder, Extension Ladder, Sectional Ladder, Trestle Ladder, Extension Trestle Ladder, Job Made Ladder

Comments:

Inspector Sub-contractor
Name: Name:
Function: Function:
Signature: Date: Signature: Date:

HSE Form # 012 Page 1 of 1