Ladder Inspection Use Form In accordance with the OSHA regulation this form is required to be completed before using a ladder. Company Name(Required)Safety Coordinator(Required) First Last Safety Coordinator Email(Required) Safety Coordinator Phone(Required)Name of Individual Conducting Inspection First Last Date of Inspection(Required) MM slash DD slash YYYY Was the ladder brought from home?(Required) Yes No Type of Ladder(Required) Stepstool Stepstool Ladder Step Ladder Construction of Ladder(Required) Wood Aluminum Fiberglass Other ENVIRONMENTAL FACTORSIs the stepstool, stepstool ladder or step ladder on a slippery surface?(Required) Yes No Is step stool, step stool ladder or step ladder near energized wires?(Required) Yes No Sepstool, stepstool ladder, or step ladder coated with opaque material(Required) Yes No INSPECTIONSteps loose, cacked, bent or mising(Required) Yes No Rails – cracked, bent, split or frayed)(Required) Yes No Labels – mssing or not readable(Required) Yes No Paint Shelf – loose, bent, missing, or broken(Required) Yes No Top Cap – cracked, loose, or missing(Required) Yes No Spreader – loose, bent,or broken(Required) Yes No General Appeaerance – rusty, corrosion, loose, dirty(Required) Yes No Feet – damaged or mssing(Required) Yes No CAREHave the spreaders been regularily lubricated ?(Required) Yes No Are the steps clean?(Required) Yes No
