Daily scaffold safety inpection report

• Document No.

• Daily Scaffold inspection

• Conducted on

  Date

• Prepared by

General Information

• Job Name & No.

  Select St. Marys 13-3174 Cameron Hospital Masonry - 13-3151 Springfield Family Ice 13-3177 Tuttle Middle School 13-3195 Police Crime Lab 13-3276 Miami University 13-3270

  • St. Marys 13-3174
  • Cameron Hospital Masonry - 13-3151
  • Springfield Family Ice 13-3177
  • Tuttle Middle School 13-3195
  • Police Crime Lab 13-3276
  • Miami University 13-3270

• General Comments

• Point of reference - elevation, column line, Unit

• Add media

  Media

Inspection

• Add media

  Media

• Are mud sills and base plates being used<br>

  Yes

  No

  N/A

• Is a safe means of access provided to working platform

  Yes

  No

  N/A

• Does ladder extend 3' above work platform

  Yes

  No

  N/A

• Is ladder secured to prevent displacement

  Yes

  No

  N/A

• Is ladder installed as scaffold is erected to provide access for erectors

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are scaffold frames plumb and 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 components free of damage

  Yes

  No

  N/A

• Are all accessible platforms planked solid

  Yes

  No

  N/A

• Are all platforms at least 18" wide

  Yes

  No

  N/A

• Is work platform maximum 14" from wall

  Yes

  No

  N/A

• Do all plank over lap 6" - 12"

  Yes

  No

  N/A

• Are all plank free of damage, splits, etc

  Yes

  No

  N/A

• Are platforms kept clear of unnecessary material and debris

  Yes

  No

  N/A

• Are guardrails installed on all platforms

  Yes

  No

  N/A

• Is top rail between 38" - 48" high and capable of supporting 200 lbs

  Yes

  No

  N/A

• Is mid-rail between 20" - 30" high and capable of supporting 200 lbs

  Yes

  No

  N/A

• Are end guard rails with toe boards in place

  Yes

  No

  N/A

• Are all material platforms equipped with toe boards

  Yes

  No

  N/A

• Are scaffolds tied off once scaffold is 4 times higher than its base (6'6" scaffold should be tied at 20')

  Yes

  No

  N/A

• Are scaffold tie offs repeated every 26' vertically after first set of ties

  Yes

  No

  N/A

• If scaffold needs to be tied off, is it tied off at both ends of scaffold and max 30' apart

  Yes

  No

  N/A

• Is scaffold at a safe distance from power lines

  Yes

  No

  N/A

• Observations or Comments

• Actions Taken

• Add media

  Media

• Foreman's Signature

  Sign

• Inspector Signature

  Sign