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UCSB Ladder Inspection Form2 02042014 REV

This document is a ladder inspection form used by UCSB to inspect step ladders, extension ladders, and specialty ladders. It records the inspector's name and signature, date inspected, and department. For each type of ladder, it lists potential areas of damage such as loose, cracked, or missing steps/rungs/rails. The inspector circles any issues found and notes whether the ladder was removed from use or is in good condition.

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659 views2 pages

UCSB Ladder Inspection Form2 02042014 REV

This document is a ladder inspection form used by UCSB to inspect step ladders, extension ladders, and specialty ladders. It records the inspector's name and signature, date inspected, and department. For each type of ladder, it lists potential areas of damage such as loose, cracked, or missing steps/rungs/rails. The inspector circles any issues found and notes whether the ladder was removed from use or is in good condition.

Uploaded by

abu7omar-1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UCSB Ladder Inspection Form

Inspected By: Signature:


(print name)
Date Inspected: Department:
STEP LADDER
TYPE: Fiberglass Aluminum Wood SIZE: Ft.
YES NO
Circle Areas of Damage
Steps: Loose, Cracked, Bent or Missing

Rails: Cracked, Bent, Split or Frayed Rail Shields

Labels: Missing or Not Readable

Pail Shelf: Loose, Bent, Missing or Broken

Top: Cracked, Loose or Missing

Spreader: Loose, Bent or Broken

General: Rust, Corrosion or Loose

Other: Bracing, Shoes, Rivets

ACTIONS: Ladder tagged as damaged & removed from use

Ladder is in good condition

EXTENSION LADDER
TYPE: Fiberglass Aluminum SIZE: Ft.
YES NO
Circle Areas of Damage Rungs: Loose, Cracked, Bent or Missing

Rails: Cracked, Bent, Split or Frayed Rail Shields

Labels: Missing or Not Readable

Rung Locks: Loose, Bent, Missing or Broken

Hardware: Missing, Loose or Broken

Shoes: Worn, Broken or Missing

Rope/Pulley: Loose, Bent or Broken

Other: Bracing Rivets

General: Rust, Corrosion or Loose

ACTIONS: Ladder tagged as damaged & removed from use

Ladder is in good condition


UCSB Ladder Inspection Form
Inspected By: Signature:
(print name)
Date Inspected: Department:
SPECIALTY LADDER
TYPE: Fiberglass Aluminum Wood SIZE: Ft.
YES NO
Circle Areas of Damage Steps/Rungs: Loose, Cracked, Bent or Missing

Rails: Cracked, Bent, Split or Frayed

Labels: Missing or Not Readable

Hardware: Missing, Loose or Broken

Fasteners: Rust. Corrosion, Loose or Missing

Spreader: Cracked, Loose, or Missing

Outriggers: Missing, Rust, Corrosion or Loose


(for scaffolding)

General: Rust, Corrosion or Loose

Hinges: Bent, Loose or Missing

Locks: Loose, Bent, Broken or Missing

Bracing: Loose, Bent, Broken or Missing


(Front/Rear)

Rivets: Rust, Corrosion, Loose or Missing

Shoes: Worn, Broken or Missing

Platform: Loose, Bent, Broken or Missing

Rail Shield: Missing or Loose

Shoulder Bolt: Rust, Corrosion or Loose

Casters: Rust, Corrosion or Loose

ACTIONS: Ladder tagged as damaged & removed from use

Ladder is in good condition

(Rev. 09/14)

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