Lake County Department Of Utilities Quarterly Ladder Inspection Form

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Lake County Department of Utilities
Quarterly Ladder Inspection Form
Location Name: ______________________________________
Date of Inspection: _______/_______/_______
Inspector’s Name (print): _______________________________
Inspector’s Signature: __________________________________
Ladder
Ladder
Steps /
Joint between
Side rails
Moving parts
Ladder shoes
Ladder is
Ladder is
Ladder is marked
Number:
Size:
Rungs
side rails and
are free
operate
are
in good
tagged out
with current
are free from
steps
from
freely
in place,
operating
of service
quarterly
grease,
are tight with
cracks,
without
working
condition?
and needs
inspection tape
oil and dirt?
no broken or
bending
binding
and free of
repaired or
on a side rail?
missing rivets?
or splitting?
or undue
excess wear?
replaced?
play?
st
nd
rd
th
1
Quarter = Blue
2
Quarter = Green
3
Quarter = Yellow
4
Quarter = Orange
Page 1 of ___
F-0009

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