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Section 1: When using a ladder FROM NOW ON, how often will you… (circle ONE):
1. Inspect the ladder for damage before using it?
Always
Sometimes
Never
Dont' know what this means
2. Clear away debris at the base and top before using it?
Always
Sometimes
Never
Dont' know what this means
3. Extend a straight ladder three feet above the working surface?
Always
Sometimes
Never
Dont' know what this means
4. Tie a straight ladder off at the bottom?
Always
Sometimes
Never
Dont' know what this means
5. Tie a straight ladder off at the top?
Always
Sometimes
Never
Dont' know what this means
6. Set a straight ladder at a 75-degree angle (4 to 1 ratio)?
Always
Sometimes
Never
Dont' know what this means
7. Use three-point climbing?
Always
Sometimes
Never
Dont' know what this means
8. Carry loads by hand up the ladder?
Always
Sometimes
Never
Dont' know what this means
9. Keep your body within the ladder rails at all times?
Always
Sometimes
Never
Dont' know what this means
10. Sit on a step?
Always
Sometimes
Never
Dont' know what this means
11. “Walk” the ladder while on it to change ladder position?
Always
Sometimes
Never
Dont' know what this means
12. Work less than 10 feet from power lines?
Always
Sometimes
Never
Dont' know what this means
13. Stand on the top step of a stepladder?
Always
Sometimes
Never
Dont' know what this means
14. Climb the back of a stepladder?
Always
Sometimes
Never
Dont' know what this means
15. Use an unopened stepladder like a straight ladder?
Always
Sometimes
Never
Dont' know what this means
Section 2: Having seen the film, please indicate whether you now agree or disagree with each statement (circle ONE).
1. Very few deaths in construction are caused by falls from ladders.
2. Fall protection programs cover ladder safety.
3. If I fall on the job, it probably won’t change the way I live my life.
4. Inspecting a ladder before using it is critical to my safety.
5. I am unlikely to die or suffer a serious injury by falling only a few feet.
6. Before today, I was likely to report any ladder safety problem to my supervisor.
7. Falling on the job would have little economic impact on me or my family.
8. Workers' Compensation will not cover all the costs of a work-related injury.
9. An excellent estimate of proper ladder angle is to stand with your feet at the base and reach out; if your finger tips touch the ladder, the angle is good.
10. Most falls on the job result in lost time.
11. I would refuse to work on an unsafe ladder.
12. I could probably catch myself if I fall from a ladder.
Thank you for your participation.
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