Giampolini - Daily Scaffold Inspection

• Job Site

• Job Number

• Date

  Date

• Prepared by

• Location
  Address

• Personnel

• 1. Scaffold components/planking in safe conditions?

  Not Applicable

  Okay

  Correction Needed

• 2. Base plates/screw jacks in contact with sills/frames; toe nailed?

  Not Applicable

  Okay

  Correction Needed

• 3. Base plates for all legs?

  Not Applicable

  Okay

  Correction Needed

• 4. Scaffold level and plumb?

  Not Applicable

  Okay

  Correction Needed

• 5. Scaffold legs properly braced?

  Not Applicable

  Okay

  Correction Needed

• 6. Proper access provided (Green Tagged)?

  Not Applicable

  Okay

  Correction Needed

• 7. Guard railings in place on all open sides and ends?

  Not Applicable

  Okay

  Correction Needed

• 8. Toe Boards/Screens installed where required?

  Not Applicable

  Okay

  Correction Needed

• 9. Scaffold tied to structure every 30' in length/26' in height

  Not Applicable

  Okay

  Correction Needed

• 10. Scaffold free of makeshift devices (i.e. boxes, pails, ladders) to increase height?

  Not Applicable

  Okay

  Correction Needed

• 11. Working level platforms fully planked between uprights?

  Not Applicable

  Okay

  Correction Needed

• 12. Ensure 12" plank overlap and 6" extension beyond supports?

  Not Applicable

  Okay

  Correction Needed

• 13. Planks overlap only over supports?

  Not Applicable

  Okay

  Correction Needed

• 14. Planks in good condition?

  Not Applicable

  Okay

  Correction Needed

15. Hazardous conditions provided for:

• a.) Power Lines?

  Not Applicable

  Okay

  Correction Needed

• b.) Wind loading?

  Not Applicable

  Okay

  Correction Needed

• c.) Possible washout of footings?

  Not Applicable

  Okay

  Correction Needed

• d.) Uplift and overturning moments?

  Not Applicable

  Okay

  Correction Needed

• 16. Personnel instructed in safe use/Scaffold User Certified (Certificate on file)?

  Not Applicable

  Okay

  Correction Needed

• 17. Scaffold release forms signed for other trades?

  Not Applicable

  Okay

  Correction Needed

• All listed maintenance items have been inspected. Items marked "Risk" have been corrected except for the following: