Hagerman Scaffold Inspection

• Audit Title

• Project Number:

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• HCC Foreman

DESIGN

• Scaffold designed by a qualified person?

  Yes

  No

  N/A

• Scaffold designed to support 4x maximum intended loads?

  Yes

  No

  N/A

SCAFFOLD SUPPORT

• Scaffold erected, moved, dismantled of altered only under the supervision of a "Competent Person" and performed by trained employees?

  Yes

  No

  N/A

• Scaffold frames resting on baseplates and mud sills or adequate firm foundation? Do all scaffolds have baseplates?

  Yes

  No

  N/A

• Footings level, solid and able to support loads without settling?

  Yes

  No

  N/A

• Checked to make sure concrete block or bricks not used to support scaffold frame or platforms?

  Yes

  No

  N/A

• All scaffold frames and uprights plumb and braced to prevent swaying and displacement?

  Yes

  No

  N/A

• All frames and panels braced by cross, horizontal, or diagonal braces which secure vertical members together laterally?

  Yes

  No

  N/A

PLATFORMS

• All platforms on working levels fully decked between uprights and guardrails?

  Yes

  No

  N/A

• Each platform a minimum 18" in width?

  Yes

  No

  N/A

• Front edge of platforms within 14" of face of work?

  Yes

  No

  N/A

• Is each platform hooked or cleated to the frame or extended at least 6" and not more than 12" past the frame?

  Yes

  No

  N/A

• Are overlapping walkboards occurring at a support and the overlap a minimum of 12"?

  Yes

  No

  N/A

ACCESS

• Scaffold more than 2' above or below point of access (ground or floor) have a ladder, stairway, integral prefabricated access frame or access from another scaffold or structure?

  Yes

  No

  N/A

• Are cross braces being used for access?

  Yes

  No

• If yes, was this corrected?

  Yes

  No

  N/A

• Are walkthrough end frames being used?

  Yes

  No

• If yes, was this corrected?

  Yes

  No

  N/A

FALL PROTECTION

• Employees more than 6' above lower level have fall protection?

  Yes

  No

  N/A

• Guardrail system secured in place?

  Yes

  No

  N/A

• Top rail between 38" - 45" high and capable of supporting 200lb with mid rails midway between top rail and platform?

  Yes

  No

  N/A

• Are toe boards, screens or barricades at heights above 6' in place if a hazard for falling objects exists?

  Yes

  No

  N/A

SUPPORTING MULTI-LEVEL SCAFFOLD

• Is the height of the scaffold greater than 4x the minimum base width?

  Yes

  No

• If yes, is scaffold restrained from tipping by tying, guying or bracing?

  Yes

  No

  N/A

• Are horizontal ties no greater than 30' apart?

  Yes

  No

  N/A

• Are vertical ties at the 4:1 ration, then every 20' apart?

  Yes

  No

  N/A

• Are outriggers installed to increase the minimum base width?

  Yes

  No

  N/A

Comments

INSPECTION

• Was the scaffold inspected by a "Competent Person" at the beginning of the day or change in work shift?

  Yes

  No

  N/A

• Foreman Signature

  Sign