Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Scaffold Audit

General Information

  • Permit #:

  • Name of Scaffold Erector:

  • Installation Date:

  • Expiration Date:

  • Renter's Name

  • Phone #:

  • Drawing on Site for Inspection?

Specific Information

  • Scaffold Height:

  • Number of Platforms Decked

Sidewalk Sheds Only

  • Are there signs on the parapets?

  • Are the lights working?

  • Is the parapet the proper height and secured?

Maintenance Information

  • Are the base plates & mud sills secured?

  • Are all the scaffold pins & bolts installed?

  • Are the legs and poles plumb, braced and not displaced?

  • Are cross braces fully attached, not bent, and not missing?

  • Are tie-ins correctly spaced, properly secured & the correct amount?

  • Are pipe clamps tight?

  • Are window jacks tight?

  • Are all the planks secured?

  • Are decking and planks in good condition?

  • Is deck fully planked?

  • Are there any gaps or open spaces (> 1") on decking?

  • Are the guardrails & toe boards secured at all places where required?

  • Is the netting extension of full length and height?

  • Is the netting secured?

  • Is there proper access to the working platform of the scaffold?

  • If access to the working platform is an extension ladder, is the ladder properly set up and secured?

  • If access to the working platform is an extension ladder, does the ladder extend 3 feet past the landing point?

  • Is the deck clean and free of debris?

Approval

  • Signature:

  • Date:

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