GCC Suspended Scaffold Checklist

• Suspended Scaffold Checklist

• Document No.

• Project Name

• Project Number

• Conducted on

  Date

• Prepared by

• Location
  Address

Read Suspended Scaffold Procedure to learn about set-up and components. Follow the recommended service schedules. Keep a log of all repairs and service.

• WORK PLATFORM:

• 1. Are all connections secure?

  Yes

  No

  N/A

• 2. Are guardrails and mid-rails in place?

  Yes

  No

  N/A

• 3. Are tow boards in place?

  Yes

  No

  N/A

• 4. Is the Safe Working Load posted?

  Yes

  No

  N/A

• 5. Are you working within the Safe Working Load?

  Yes

  No

  N/A

• REMARKS

• HOSTING EQUIPMENT

• 1. Do the cables hang vertical from the outrigger beams to the stirrups?

  Yes

  No

  N/A

• 2. Do the cables hang vertical below the Hi-Lo Power lift unit?

  Yes

  No

  N/A

• 3. Do the cables extend to the ground?

  Yes

  No

  N/A

• 4. Are the cable hooks equipped with safety latches?

  Yes

  No

  N/A

• 5. Are the shackles bolted with cotter pins in place or wired through the shackle pin eye?

  Yes

  No

  N/A

• 6. Has a trial lift been made with the platform?

  Yes

  No

  N/A

• 7. Has the proper clearance from power lines been maintained?

  Yes

  No

  N/A

• 8. Have you checked to see if anything will interfere with the operation of the platform?

  Yes

  No

  N/A

• 9. Has the spring action an the secondary brake been checked?

  Yes

  No

  N/A

• 10. Are the Tulto clamps (Drop Strop) installed above the HI-Lo unit?

  Yes

  No

  N/A

• REMARKS

• OUTRIGGER BEAM

• 1. Are the beams free of bends and twists?

  Yes

  No

  N/A

• 2. Are the lock pins in place?

  Yes

  No

  N/A

• 3. Are the suspension lines properly attached to the beams?

  Yes

  No

  N/A

• 4. Are the beams and counterweights fed back?

  Yes

  No

  N/A

• 5. Are the tie back anchor points capable of withstanding a load of 5000 Lbs?

  Yes

  No

  N/A

• 6. Are the tie back lines protected from abrasion?

  Yes

  No

  N/A

• 7. Are the beams the correct size for the suspended platform?

  Yes

  No

  N/A

• 8. Are the correct size beams being used?

  Yes

  No

  N/A

• 10. Are beams adequately supported?

  Yes

  No

  N/A

• REMARKS

• WORK PLATFORM:

• 1. Is the number of counterweights correct for the application?

  Yes

  No

  N/A

• 2. Are the counterweights correct for the application?

  Yes

  No

  N/A

• 3. Are the counterweights compatible with the outrigger beams?

  Yes

  No

  N/A

• REMARKS

• FALL PROTECTION

• 1. Are the life lines attached to anchor point capable of withstanding?

  Yes

  No

  N/A

• 2. Are the life lines made of synthetic rope capable of withstanding 5000 Lbs?

  Yes

  No

  N/A

• 3. Do the life lines go to the ground or next lower level?

  Yes

  No

  N/A

• 4. Is there an independent anchor point for each life line?

  Yes

  No

  N/A

• 5. Are the life lines protected from mechanical damage?

  Yes

  No

  N/A

• 6. Are workers wearing a full body harness and is it properly attached?

  Yes

  No

  N/A

• 7. Are the rope grabs above the workers?

  Yes

  No

  N/A

• 8. Is there a safe access/egress point for the worker to enter and/or exit the scaffold?

  Yes

  No

  N/A

• REMARKS

• GENERAL

• 1. Has the area below the swing stage been ribboned off?

  Yes

  No

  N/A

• 2. Are all tools secured to the platform?

  Yes

  No

  N/A

• 3. Are all power cords grounded properly?

  Yes

  No

  N/A

• 4. Have all workers been trained to perform the job?

  Yes

  No

  N/A

• 5. Has a rescue plan been discussed and communicated to all workers?

  Yes

  No

  N/A

• 6. Has the swing stage been setup according to the approved drawing or plan?

  Yes

  No

  N/A

• REMARKS

• Inspected by and Signature:

  Sign

• Reinspected by and Signature:

  Sign