Information
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Job Site
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Job Number
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Date
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Prepared by
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Location
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Personnel
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1. Scaffold components/planking in safe conditions?
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2. Base plates/screw jacks in contact with sills/frames; toe nailed?
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3. Base plates for all legs?
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4. Scaffold level and plumb?
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5. Scaffold legs properly braced?
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6. Proper access provided (Green Tagged)?
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7. Guard railings in place on all open sides and ends?
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8. Toe Boards/Screens installed where required?
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9. Scaffold tied to structure every 30' in length/26' in height
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10. Scaffold free of makeshift devices (i.e. boxes, pails, ladders) to increase height?
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11. Working level platforms fully planked between uprights?
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12. Ensure 12" plank overlap and 6" extension beyond supports?
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13. Planks overlap only over supports?
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14. Planks in good condition?
15. Hazardous conditions provided for:
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a.) Power Lines?
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b.) Wind loading?
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c.) Possible washout of footings?
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d.) Uplift and overturning moments?
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16. Personnel instructed in safe use/Scaffold User Certified (Certificate on file)?
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17. Scaffold release forms signed for other trades?
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All listed maintenance items have been inspected. Items marked "Risk" have been corrected except for the following:
