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  • UCSB Ladder Inspection Form2 02042014 REV

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    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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    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    85 views2 pages

    UCSB Ladder Inspection Form2 02042014 REV

    Uploaded by

    abu7omar-1
    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.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    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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