Ladder Inspection Form Provided by Werner Co.

Company Name:

Ladder Reference Number: Dept.

Inspector: Dept.

STEPLADDER PODIUM EXTENSION LADDER

Size: ________ ft. Size: ________ ft. Size: ________ ft.

Fiberglass Fiberglass Fiberglass

Aluminum Aluminum Aluminum

Wood Wood

Circle Areas Circle Areas Circle Areas

of Damage 6206 of Damage PD6204 of Damage D6224

YES NO YES NO YES NO

Steps: Steps: Rungs:
Loose, cracked, bent, or missing Loose, cracked, bent, or missing Loose, cracked, bent, or missing
Rails: Rails: Rails:
Cracked, bent, split or frayed Cracked, bent, split or frayed Cracked, bent, split, or frayed
rail shields rail shields Labels:
Labels: Labels: Missing or not readable
Missing or not readable Missing or not readable Rung Locks:
Pail Shelf: Top: Loose, bent, missing, or broken
Loose, bent, missing, or broken Cracked, loose, or missing Hardware:
Top: Spreader: Damaged, loose, or missing
Cracked, loose, or missing Loose, bent, or broken Shoes:
Spreader: Platform: Worn, broken, or missing
Loose, bent, or broken Cracked or bent Rope / Pulley:
General: General: Loose, bent, or broken
Rust, corrosion, or loose Rust, corrosion, or loose General:
Other: Other: Rust, corrosion, or loose
Bracing, shoes, or rivets Bracing, shoes, or rivets Other:
Bracing rivets

ACTIONS: ACTIONS: ACTIONS:

Ladder tagged as damaged Ladder tagged as damaged Ladder tagged as damaged
and removed from use and removed from use and removed from use
Ladder is in good condition Ladder is in good condition Ladder is in good condition
Ladder Inspection Form, Continued
Provided by Werner Co.

SPECIALTY LADDER Model Number: _______________________

Fiberglass
Mark all that apply YES NO
Aluminum
Steps / Rungs:
Loose, cracked, bent, or missing
Wood
Rails:
Cracked, bent, split, or frayed
Labels:
Missing or not readable
Hardware:
Missing, loose, or broken
Fasteners:
Rust, corrosion, loose, or missing
Top:
Cracked, loose, or missing
Spreader:
Loose, bent, or broken
Outriggers:
Missing, rust, corrosion, or
loose for scaffolding
General:
PT1074-4C E1078 M7108-1
Rust, corrosion, or loose
Hinges:
Loose, bent, or missing
Locks:
Loose, bent, broken, or missing
Bracing Front, Rear:
Loose, bent, broken, or missing
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
for scaffolding

ACTIONS:
Ladder tagged as damaged
and removed from use
Ladder is in good condition
4203-18

GM6407 © 2017 Werner Co. Printed in U.S.A.