Chamdor Brewery Scaffold Inspection Register

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Inspection Details

• Date of Inspection:

  Date

• Inspector Name and License Number:

Scaffold Erectors' Details:

• Company Erecting Scaffold:

• Erectors' Name and License Number:

• COID Letter of Good Standing Current and Available?

  Yes

  No

  N/A

• Medical Fitness Certificates Inspected for all Employees?

  Yes

  No

  N/A

• SHE Induction done by all Employees?

  Yes

  No

  N/A

Inspection Criteria:

Foundation

• Surface level

  Yes

  No

  N/A

• Sole plates in place

  Yes

  No

  N/A

• Base plates in place

  Yes

  No

  N/A

• Jack used

  Yes

  No

  N/A

Ties

• Structure sound

  Yes

  No

  N/A

• Sufficient ties used

  Yes

  No

  N/A

• Ties tightened

  Yes

  No

  N/A

Bracing

• Complete lines

  Yes

  No

  N/A

• Sufficient types

  Yes

  No

  N/A

• Correct fitting

  Yes

  No

  N/A

Platforms

• Boards properly supported

  Yes

  No

  N/A

• Boards used are sturdy

  Yes

  No

  N/A

• Toe boards are used

  Yes

  No

  N/A

• Handrails in place

  Yes

  No

  N/A

• Platforms not overloaded

  Yes

  No

  N/A

Access

• Lads in place

  Yes

  No

  N/A

• Ladders secured

  Yes

  No

  N/A

• 900mm above platform

  Yes

  No

  N/A

• Sound condition

  Yes

  No

  N/A

• Properly supported

  Yes

  No

  N/A

Standards

• Vertical

  Yes

  No

  N/A

• Sound condition

  Yes

  No

  N/A

• Correctly spaced

  Yes

  No

  N/A

Ledgers

• Correctly spaced

  Yes

  No

  N/A

• Firmly fixed

  Yes

  No

  N/A

• Sound condition

  Yes

  No

  N/A

• Transen (short ledger)

  Yes

  No

  N/A

Mobiles

• Correct castors

  Yes

  No

  N/A

• Height ration

  Yes

  No

  N/A

• Braced

  Yes

  No

  N/A

• Brakes

  Yes

  No

  N/A

Suspended Platform

• Sound equipment

  Yes

  No

  N/A

• Not overloaded

  Yes

  No

  N/A

• Secure outriggers

  Yes

  No

  N/A

• Lifting gear

  Yes

  No

  N/A

• Wire ropes

  Yes

  No

  N/A

• Shackles

  Yes

  No

  N/A

• Safety belt available

  Yes

  No

  N/A

Signage

• Placed as required

  Safe

  At Risk

  N/A

Signatures:

• Inspector:

  Sign

• Erector:

  Sign

• Manager:

  Sign

Is Scaffold SAFE or NOT SAFE for use?

• Declared Safe/Not Safe for Use:

  Safe

  Not Safe

• Photo of Scaffold:

  Media