CLIENT & LOCATION
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Project
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Job Number
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Conducted on
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Prepared by
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Location
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What-3-Words
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Specific Location & Name
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Client Name
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Reason for visit
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Sector
Client Submitted Information
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Are there structural drawings available ? ?
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What Format ?
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Has the client or their client submitted Design Brief?
- Yes
- No
- N/A
Scaffold Principles
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Is the scaffold Internal / External / Both
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Specified Materials
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Will Extendable Transoms be used?
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Cladding
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Does the scaffold require a temporary roof?
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Type of roof?
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Type of Scaffold
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Describe scaffold
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Load Class
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Type of Ties
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Independent Board Gauge
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Boarded Lifts
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Specified Access
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Are prefabricated beams required?
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What beams are to be used?
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Ground Specification
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What is the ground condition if not stated
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Base material of main structure
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Does the scaffold involve roof work?
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What is the roof material
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Is the pitch of the roof greater than 10°
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Does the scaffold require a fan?
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What Class of Fan ?
Scaffold Details
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Description of Scaffold(s)
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Images
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Main Dimensions (Height Length Width)
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Structure Dims & Sketches
Design Risk Assessment
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Are there any related risks
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Describe Risk
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Provide Images (If Possible)
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Is the project affiliated to Network Rail?
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Does a FORM C have to be completed
- YES
- NO
- TBC - ENGINEER TO CONFIRM WITH SENIOR MANAGEMENT
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Is a CAT 3 Check Required
Sign Off
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Completed By
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Date & Time