LadderInspectionFormCompanyName:LadderReferenceNumber:InspectorPleasePrintDept.StepladderSizeft.KExtensionLadderSizeft.KKFiberglassKAluminumKWoodKFiberglassKAluminumSteps:Loose,Cracked,BentorMissingKKRails:Cracked,Bent,SplitorFrayedRailShieldsKKLabels:MissingorNotReadableKKPailShelf:Loose,Bent,MissingorBrokenKKTop:Cracked,LooseorMissingKKSpreader:Loose,BentorBrokenKKGeneral:Rust,CorrosionorLooseKKOther:Bracing,Shoes,RivetsKKRungs:Loose,Cracked,BentorMissingKKRails:Cracked,Bent,SplitorFrayedKKLabels:MissingorNotReadableKKRungLocks:Loose,Bent,MissingorBrokenKKHardware:Missing,LooseorBrokenKKShoes:Worn,BrokenorMissingKKRope/Pulley:Loose,BentorBrokenKKOther:BracingRivetsKKGeneral:Rust,CorrosionorLooseKKYesNoYesNoCircleAreasofDamageCircleAreasofDamageActions:KLaddertaggedasdamaged&removedfromuseKLadderisingoodconditionActions:KLaddertaggedasdamaged&removedfromuseKLadderisingoodconditionDate.ProvidedbyWernerCo.Actions:KLaddertaggedasdamaged&removedfromuseKLadderisingoodcondition®®SpecialtyLadderKKFiberglassKAluminumKWoodSteps/Rungs:Loose,CrackedBentorMissingKKRails:Cracked,Bent,SplitorFrayedKKLabels:MissingorNotReadableKKHardware:Missing,LooseorBrokenKKFasteners:Rust,Corrosion,LooseorMissingKKTop:Cracked,Loose,orMissingKKSpreader:Loose,BentorBrokenKKOutriggers:Missing,Rust,CorrosionorLooseforscaffoldingKKGeneral:Rust,CorrosionorLooseKKHinges:Loose,BentorMissingKKLocks:Loose,Bent,BrokenorMissingKKBracingFront,Rear:Loose,Bent,BrokenorMissingKKRivets:Rust,Corrosion,Loose,MissingKKShoes:Worn,BrokenorMissingKKPlatform:Loose,Bent,BrokenorMissingKKRailShield:MissingorLooseKKShoulderBolt:Rust,CorrosionorLooseKKCasters:Rust,CorrosionorLooseforscaffoldingKKYesNoModelNumber:MarkallthatapplyGM6407©2004WernerCo.PrintedinU.S.A.August2004LadderInspectionFormProvidedbyWernerCo.