IIS Space Ireland – Ladder – Permit Requested – Docusafe

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IIS Space Ireland - Ladder - Permit Requested

To be completed by all IIS Space Personnel

"*" indicates required fields

Project Name*

Subcontractor*

Form Completed by*

First Last

Email Address*

Type Of Ladder*

Ladder Identification Number*

Ladder inspected by competent person*

Yes

No

N/A

No broken, bent, or missing steps, rungs or rails*

Yes

No

N/A

Floor, steps and rungs free of water, oil, ice or other slippery substance*

Yes

No

N/A

No sharp edges, cuts or burrs*

Yes

No

N/A

Spreaders and locks are functional and in good condition*

Yes

No

N/A

Damaged ladders tagged and removed from service*

Yes

No

N/A

Ladder level, stable and on solid ground*

Yes

No

N/A

Trained in ladder safety*

Yes

No

N/A

Second worker providing assistance to stabilize ladder, hand up tools, etc*

Yes

No

N/A

Nonslip bases and/or safety feet in good condition*

Yes

No

N/A

Fall protection provided in accordance with company policy*

Yes

No

N/A

Stepladder is fully open and locked*

Yes

No

N/A

Date*

DD slash MM slash YYYY

Sign On

Permit Requested By

Site Manager Signature

Hidden

Date of cancellation or closing of the permit*

DD slash MM slash YYYY

Hidden

Contractor Sign Off

Hidden

Site Manager sign off

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