LADDER SITE SURVEY
To be carried out before the use of any Ladder. This is to be completed by a competent operative.
YOUR RESPONSIBILITIES
¡ Always, your overriding concern has to be for your safety and the safety of anyone else who is affected by what you do.
¡ You must always read and follow the manufacturer’s instruction manual and on no account attempt to use equipment beyond it limitations. You must never use ladders whilst under the influence of alcohol or drugs.
¡ You must not misuse or abuse equipment and you must not interfere with devices which are provided for your safety.
¡ You must follow the training and instructions given to you, unless you think it would be unsafe to do so.
Date of Use / Job No.Time of Use
Name of All Persons Involved
Exact Location of Use
Description of Job
Control Measures
My Ladder / Comments / Yes / NoIs my ladder manufacturer’s instructions available and have I read and understood them? Is it strong enough for the tasks?
I have read and understood the GEN 4.0 Use of Ladders risk assessment.
Is my Ladder capable of reaching the working height? Can I erect it at correct angle (1:4)?
Have I checked my Ladder for wear, tear and damage affecting safety? (e.g. rungs, stiles and dents. If in doubt DON’T USE IT).
Can I carry my Ladder and position it safely without slipping, tripping or falling?
Number of people working on ladder?
Are ground conditions suitable? (Firm, level and stable) Should the Ladder be secured? If yes, please describe how. / How have you secured your ladder?
Do the weather conditions allow for safe use of the Ladder? (e.g. Wind, rain, snow, ice)
What is the frequency and duration of the job without a break?
Can I carry materials, equipment and tools, climb the ladder and work safely maintaining 3 points of contact?
Can I place my Ladder to avoid overreaching and sideways-on loading on each task?
Could sudden unexpected movement cause me to fall off my Ladder and how serious are the consequences of falling?
Should I segregate the working area around my Ladder to protect it and other personnel?
PERSONAL PROTECTIVE EQUIPMENT REQUIRED
Hard Hats / Safety Footwear / Eye Protection / Ear Protection / Hand ProtectionBreathing aids / Hi-Vis Vests / Wet Weather Gear / Dust / Fume Protection
We the undersigned have read and fully understand the details contained within this site survey.
The hazards I have identified are controlled by appropriate measures detailed on the previous page are deemed to be suitable for this site and the activities to be undertaken.
Name / Date / SignatureSupervisor Signature (Works above 2metres)
Please return to Estates & Facilities Health & Safety Advisor