Appendix L: Daily Scaffold Safety Inspection Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Inspection Criteria

• Are 2"x10" mud sills and base plates used?

  Yes

  No

  N/A

• If CMU piers are used for footings are they poured solid?

  Yes

  No

  N/A

• Are all components free of damage?

  Yes

  No

  N/A

• Are Scaffold frames plumb & level?

  Yes

  No

  N/A

• Are scaffold frames pinned together to prevent displacement?

  Yes

  No

  N/A

• Are cross braces used at all locations?

  Yes

  No

  N/A

• Are frames and braces compatible?

  Yes

  No

  N/A

• Are all working levels fully planked (Max. 1" gap between planks)?

  Yes

  No

  N/A

• All platforms are at least 18" wide?

  Yes

  No

  N/A

• Is the work platform not more than 14" from the wall?

  Yes

  No

  N/A

• Do all planks overlap their end supports 6"-12"?

  Yes

  No

  N/A

• Are scaffold planks free of damage, splits, ect?

  Yes

  No

  N/A

• Are scaffolds secured to the structure once the scaffold is 4 times as high as it is wide including guardrails?

  Yes

  No

  N/A

• Are scaffold ties repeated every 26' vertically after the first set of ties?

  Yes

  No

  N/A

• Where scaffold ties are required are they installed at both ends of the scaffold and at 30' max. intervals between ends?

  Yes

  No

  N/A

• Is a safe means of access provided to all scaffold platforms more than 2' high? (Extension ladders, attachable ladders, stairs or integral ladder access frames must be used)

  Yes

  No

  N/A

• Does the ladder extend 3' above the platform?

  Yes

  No

  N/A

• Are ladders secured to prevent displacement?

  Yes

  No

  N/A

• Are ladders installed as scaffold is erected to provide access for erectors?

  Yes

  No

  N/A

• Are scaffolds at safe distances from power lines?

  Yes

  No

  N/A

• Are tag lines used when hoisting loads onto scaffolds with cranes?

  Yes

  No

  N/A

• Are guardrails installed on all platforms over 6' high?

  Yes

  No

  N/A

• Is the top rail between 38"- 45" high and capable of supporting 200lbs?

  Yes

  No

  N/A

• Are mid-rails capable of supporting 150 lbs?

  Yes

  No

  N/A

• Where cross bracing is used as a midrail is the crossing point of the brace between 20"- 30" above the work platform?

  Yes

  No

  N/A

• Where cross bracing is used as a top rail is the crossing point of the brace between 38"- 48" above the work platform? (Cross brace cannot serve as both the top rail and the midrail)

  Yes

  No

  N/A

• Are platforms kept clear of unnecessary material and debris?

  Yes

  No

  N/A

• Are all material platforms equipped w/ toeboards?

  Yes

  No

  N/A

• Are all areas below and around scaffolds barricaded to prevent workers from walking under scaffolds?

  Yes

  No

  N/A

• Are canopies erected when workers must pass under scaffolds?

  Yes

  No

  N/A

• Are all scaffolds that are incomplete tagged "Danger Do Not Use"?

  Yes

  No

  N/A

• Are all damaged components removed from service and tagged "Danger Do Not Use"?

  Yes

  No

  N/A

• Are there legible scaffold tags at each access point?

  Yes

  No

  N/A

• Is the tag proper for the scaffold condition? (red, yellow, or green)

  Yes

  No

  N/A