Ladder Inspection Form - University of California, …

1 Ladder Inspection FormCompany Name: Ladder Reference Number:InspectorPlease :Loose, Cracked, Bent or MissingqqRails:Cracked, Bent, Split or FrayedRail ShieldsqqLabels:Missing or Not ReadableqqPail Shelf:Loose, Bent, Missing or BrokenqqTop:Cracked, Loose or MissingqqSpreader:Loose, Bent or BrokenqqGeneral:Rust, Corrosion or LooseqqOther:Bracing, Shoes, RivetsqqRungs:Loose, Cracked, Bent or MissingqqRails:Cracked, Bent, Split or FrayedqqLabels:Missing or Not ReadableqqRung Locks:Loose, Bent, Missing or BrokenqqHardware:Missing, Loose or BrokenqqShoes:Worn, Broken or MissingqqRope/Pulley:Loose, Bent or BrokenqqOther:Bracing RivetsqqGeneral:Rust, Corrosion or LooseqqYesNoYesNoCircle Areasof DamageCircle Areasof DamageActions:qLadder tagged as damaged & removed from useqLadder is in good conditionActions:qLadder tagged as damaged & removed from useqLadder is in good by Werner Co.

2 Actions:qLadder tagged as damaged & removed from useqLadder is in good condition Specialty LadderqqFiberglassqAluminumqWoodSteps/Ru ngs:Loose, Cracked Bent or MissingqqRails:Cracked, Bent, Split or FrayedqqLabels:Missing or Not ReadableqqHardware:Missing, Loose or BrokenqqFasteners:Rust, Corrosion, Loose or MissingqqTop:Cracked, Loose, or MissingqqSpreader:Loose, Bent or BrokenqqOutriggers:Missing, Rust, Corrosion or Loosefor scaffoldingqqGeneral:Rust, Corrosion or LooseqqHinges:Loose, Bent or MissingqqLocks:Loose, Bent, Broken or MissingqqBracingFront,Rear:Loose, Bent, Broken or MissingqqRivets:Rust, Corrosion, Loose, MissingqqShoes:Worn, Broken or MissingqqPlatform:Loose, Bent, Broken or MissingqqRail Shield:Missing or LooseqqShoulder Bolt:Rust, Corrosion or LooseqqCasters:Rust, Corrosion or Loosefor scaffoldingqqYesNoModel Number:Mark all that applyGM6407 2004 Werner in August 2004 Ladder Inspection FormProvided by Werner Co.