Title Page

  • Document No.

  • Customer

  • Address

  • Conducted on

  • Prepared by

  • Location

TASK

  • TASK

  • Are all Hazards/Risks identified in the Safe Work Method Statement. A hard copy is located in each truck and digitally.

  • Identify Potential hazards and control Measures put in place prior to commencing work

  • Please detail Potential Hazards and control measures put in place.

  • Do I have the correct PPE/ TOOLS to complete the task safley

  • New Install / Saftey Check / Removal

  • Are internal voids proteted?

  • Install ELITE void system and complete VOID handover certificate before comencing.

  • Are all balconies protected with FALLGUARD Prior to accessing?

  • Install FALLGUARD and complete FALLGUARD handover certificate

  • Are there any Lost or damaged Items?

  • List Lost or damaged Items

  • undefined

  • Are internal voids proteted?

  • Install ELITE void system and complete VOID handover certificate before comencing.

  • Are all balconies protected with FALLGUARD Prior to accessing?

  • Install FALLGUARD and complete FALLGUARD handover certificate

  • Are internal voids proteted?

  • Install ELITE void system and complete VOID handover certificate before comencing.

  • Are all balconies protected with FALLGUARD Prior to accessing?

  • Install FALLGUARD and complete FALLGUARD handover certificate

  • Are All hangers correctly fitted and secured?

  • Are Trusses installed and fixed securely?

  • If HANG-ON has been installed PRE TRUSS are back braces and top plate corner braces installed as per installation manual?

  • Are all Hand rails secured (clipped) ensuring overlapping past post (minimum 100mm) and all corner posts installed.

  • Are all boards secured as per instruction manual?

  • Is there safe Access to Elevated Work area

  • Do a Site walk around and ensure All Excess gear taken from site?

  • Has scaffold tag been fitted with correct information at access point?

  • Take a Photo of Scaffold Tag

  • Take photo of each Elevation

  • Are internal voids proteted?

  • Install ELITE void system and complete VOID handover certificate before comencing.

  • Are all balconies protected with FALLGUARD Prior to accessing?

  • Install FALLGUARD and complete FALLGUARD handover certificate

  • Are internal voids proteted?

  • Install ELITE void system and complete VOID handover certificate before comencing.

  • Are all balconies protected with FALLGUARD Prior to accessing?

  • Install FALLGUARD and complete FALLGUARD handover certificate

  • Are All hangers correctly fitted and secured?

  • Are Trusses installed and fixed securely?

  • If HANG-ON has been installed PRE TRUSS are back braces and top plate corner braces installed as per installation manual?

  • Are all Hand rails secured (clipped) ensuring overlapping past post (minimum 100mm) and all corner posts installed.

  • Are all boards secured as per instruction manual?

  • Is there safe Access to Elevated Work area

  • Do a Site walk around and ensure All Excess gear taken from site?

  • Has scaffold tag been fitted with correct information at access point?

  • Take a Photo of Scaffold Tag

  • Take photo of each Elevation

  • Have i read and understood my SWMS for this task.

  • DO NOT commence work until SWMS is read and understood for this task and all potential hazards are identified and control measures put in place

  • Are all Hazards/Risks identified in the Safe Work Method Statement. A hard copy is located in each truck and digitally.

  • Identify Potential hazards and control Measures put in place prior to commencing work

  • Do I have the correct PPE/ TOOLS to complete the task safley

  • Activity

  • SAFE WORKING LOAD OF VOID PLATFORM

  • Are all Void Supports within allowable spans as per the installation Manual (max 2.5m)

  • Have Center supports been installed

  • Are all Panels in place maintaining maximum 225mm to all working faces?

  • Is there a maximum 100mm distance on designated walk off to floor?

  • Is there a ladder bracket fitted preventing movement of ladder and maintaining a 4 :1 ratio and minimum 900mm protruding past top of void?

  • Has scaffold tag been fitted with correct information on ladder?

  • Take Photo from top of void

  • Take photo of underside of void

  • Take photo of ladder

  • Take photo of scaff tag

  • Ladder Removed from site

  • Is all gear accounted For

  • List Missing/Damaged Items

  • Ladder Removed from site

  • SAFE WORKING LOAD OF VOID PLATFORM

  • Are all Void Supports within allowable spans as per the installation Manual (max 2.5m)

  • Have Center supports been installed

  • Are all Panels in place maintaining maximum 225mm to all working faces?

  • Is there a maximum 100mm distance on designated walk off to floor?

  • Is there a ladder bracket fitted preventing movement of ladder and maintaining a 4 :1 ratio and minimum 900mm protruding past top of void?

  • Has scaffold tag been fitted with correct information on ladder?

  • Take Photo from top of void

  • Take photo of underside of void

  • Take photo of ladder

  • Take photo of scaff tag

  • Have i read and understood my SWMS for this task.

  • DO NOT commence work until SWMS is read and understood for this task and all potential hazards are identified and control measures put in place

  • Are all Hazards/Risks identified in the Safe Work Method Statement. A hard copy is located in each truck and digitally.

  • Identify Potential hazards and control Measures put in place prior to commencing work

  • Do I have the correct PPE/ TOOLS to complete the task safley

  • Erection/Modification/Dismantle

  • Is all Equipment accounted for.

  • Detail all missing/Damaged Components

  • SAFE WORKING LOAD OF MOBILE SCAFFOLD

  • Type of scaffolding

  • Is the scaffolding over 2m Deck Height

  • Outriggers Need to be fitted

  • Is the Scaffolding 3m Deck Height

  • Outriggers Need to be fitted

  • Is there a ladder bracket fitted preventing movement of ladder and maintaining a 4 :1 ratio?

  • Has scaffold tag been fitted with correct information on ladder?

  • Take photo of scaffolding

  • Take photo of ladder

  • Take photo of scaff tag

  • SAFE WORKING LOAD OF MOBILE SCAFFOLD

  • Type of scaffolding

  • Is the scaffolding over 2m Deck Height

  • Outriggers Need to be fitted

  • Is the Scaffolding 3m Deck Height

  • Outriggers Need to be fitted

  • Is there a ladder bracket fitted preventing movement of ladder and maintaining a 4 :1 ratio?

  • Has scaffold tag been fitted with correct information on ladder?

  • Take photo of scaffolding

  • Take photo of ladder

  • Take photo of scaff tag

  • Have i read and understood my SWMS for this task.

  • DO NOT commence work until SWMS is read and understood for this task and all potential hazards are identified and control measures put in place

  • Are all Hazards/Risks identified in the Safe Work Method Statement. A hard copy is located in each truck and digitally.

  • Identify Potential hazards and control Measures put in place prior to commencing work

  • Do I have the correct PPE/ TOOLS to complete the task safley

  • Install / Modification / Removal

  • Is all Gear Accounted for

  • List all lost/Damaged Components

  • Are internal voids proteted?

  • Install ELITE void system or Hand rail around Void.

  • Are All Brackets fixed Securely to structurally sound frames, beams and trusses?

  • Are all Hand rails secured (clipped) ensuring overlapping past post (minimum 100mm) and all corner posts installed.

  • Is there safe Access to Elevated Work area

  • All Excess gear taken from site?

  • Has scaffold tag been fitted with correct information at access point?

  • Take photo of each Elevation

  • Installed By

  • Have i read and understood my SWMS for this task.

  • DO NOT commence work until SWMS is read and understood for this task and all potential hazards are identified and control measures put in place

  • Are all Hazards/Risks identified in the Safe Work Method Statement. A hard copy is located in each truck and digitally.

  • Identify Potential hazards and control Measures put in place prior to commencing work

  • Do I have the correct PPE/ TOOLS to complete the task safley

  • Erection/ MODIFICATION/ DISMANTLE

  • IS there any Lost or damaged Equipment

  • List Equipment

  • TYPE OF SCAFFOLDING

  • SWL OF SCAFFOLDING (INCLUDING MEN AND MATERIALS)

  • DATE OF HANDOVER

  • NAME OF COMPETENT PERSON

  • SIGNATURE OF COMPETENT PERSON

  • PHOTOS OF SCAFFOLDING INCLUDING ACCESS POINT. SCAFFOLD TAG AND EACH ELEVATION

  • Installed By

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.