Page 1: Initial questions
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Conducted on
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Prepared by
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Principal Contractor / Client
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Location
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Site Instruction Number
Disclaimer
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This Scaffold detailed has been erected in alignment with its technical drawings, scaffold code of practice and is suitable for its intended purpose at the time of handover. Scaffold inspections every 30 days maximum or immediately following any incident which may affect the adequacy of the scaffold
Page 2: Main checklist
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Project Details
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Description of area handed over
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Intended use of Scaffold?
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Plant Design Registration No.
Risk Assessment and Pre-Start
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Risk Assessment Completed ?
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Pre-Start Completed ?
Duty Classification
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Light (225 kg)
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Medium (450 kg)
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Heavy (675 kg)
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Special
No. of working decks
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2.4 m Bays
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1.8m Bays
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1.2m Bays
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.7m Bays
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TWP Height
Page 3: Materials and Labour
Description of Materials installed
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Materials
Labour Description
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No. of men on site?
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Hours on site?
Installation
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Has the Scaffold been built in accordance with AS/NZS 1578(1-5) and AS/NZS 4576?
Re-Inspection
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Has it been explained to client that Scaffold inspections required every 30 days, or immediately following any incident which may affect integrity of Scaffold?
Photos of completed works
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Site photos of completed works and sign off tag
Sign off
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AES Representive Name
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Certificate Number
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Date and Time
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Acceptance on behalf of Client
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Client Representive Name
Standard Clause Covering Orders
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1. It is to be noted that the Terms of Hire and Terms and conditions of Sale found overleaf will apply to any Variation Work
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2. This signed docket will be taken to supersede any conditions relative to additional work contained in the purchase order (Head Contract) of the client at the commencement of the contract works.
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All hire materials supplied for variation work to commence from date of delivery and finished when material is returned back yard.
