Posted by Jeffrey Jacobs, M.D., M.P.H.

Superstition holds that walking under a ladder is bad luck.

Falling from a ladder is far more than bad luck: It can result in real-life pain, suffering, disability and even death.

Annual national estimates of ladder-related fatalities range from 100 to 300, while more than 500,000 Americans are treated for ladder-related injuries. The cost of injuries is at least $24 billion in work loss, medical care, legal liability, and pain and suffering, according to the U.S. Consumer Product Safety Commission.

In 2017, March was declared National Ladder Safety Month to heighten awareness, reinforce training, and educate homeowners and workers about safe ladder use. The American Ladder Institute (ALI), a major supporter of Ladder Safety Month, provides related recommendations.

Safe Ladder Use

Before an employee uses a ladder, a fitness evaluation is recommended. This typically occurs during a post-offer or annual physical examination. An assessment may include weight, body mass index,  cardiac index or Framingham Cardiac Risk calculations, and/or human performance evaluations (e.g., ladder climbing ability, grip strength, step tests). Findings may be used to exclude individuals whose safety could be compromised while climbing due to health conditions such as cardiac disease, uncontrolled seizure disorders, neurological conditions that impact balance and coordination, and use of medication or illegal substances that impair function.

In the workplace, ALI advises employers to identify potential worksite hazards. For example, overhead power sources present an electrocution risk. (Aluminum ladders have an electrical conduction property.) In addition, when choosing the type of ladder to use (e.g., step, extension, platform, step stool, extension or folding), the surface it will be placed on must be considered. Is it soft, hard, uneven or level terrain? Proper ladder length must also be addressed.

Safety Tips

How far up?

An employee should never stand on the cap or next-highest rung of a stepladder because of balance issues. For extension ladders, the top three rungs should not be used.

What about weight?

Ladder duty ratings measure the upper limit weight capacity that a ladder can safely support. Capacity calculations include the user’s body weight and the weight of clothing and footwear, personal protective equipment, tools, and supplies being carried and/or stored on the ladder. It’s important  to remember that weight measurements taken during a post-offer physical may not include added items. The ladder duty rating is found on the side of the ladder and ranges from light duty (up to 200 pounds) to extremely heavy duty (up to 375 pounds).

What does OSHA recommend?

The Occupational Safety and Health Administration’s basic ladder safety training recommendations include:

• Avoiding electrical hazards
• Maintaining three points of contact while climbing  (two hands and a foot or two feet and a hand)
• Never shaking, shifting or moving a ladder while someone is on it
• Always securing the top or bottom of the ladder to prevent displacement on unstable or uneven surfaces
• Setting up the ladder at the correct angle

For more suggestions, refer to OSHA’s Quick Card on Portable Ladder Safety and the OSHA/National Institute for Occupational Safety and Health’s fall prevention and ladder safety smartphone app.

Ladder climbing is often an essential job function. A thorough physical assessment, training and monitoring on safe use is essential to help prevent injuries and fatalities…and they may even ward off bad luck.

Dr. Jacobs is Vice President/Clinical Lead of WorkCare’s Medical Exams & Travel division and an Associate Medical Director.