Handover Certificate - ALB Scaffolding

• Site Location
  Address

• Produced by

• Conducted on

  Date

• Contract Item Number/Variation number

• Scaffold Location/Elevation

A Design Drawing ref. or TG20 Compliance Sheet must be completed for all Scaffolding Structures

• Does the work require bespoke design?

  Yes

  No

• Have we got a TG20:21 Compliance sheet in place?

  I Confirm

  No

• Confirm that there is a Design Drawing for this structure which is issued<br>for construction and saved in the relevant digital site file/contracts<br>folder.

  I Confirm

  No

• Design Drawing Reference Number

Description of works carried out

• Please describe works that have been carried out

Scaffold Items

• Please select type of scaffold

  Select Independent Birdcage Tower Temporary roof Cantilevered Gantry Scaffold Loading Bay Staircase Adaption Other

  • Independent
  • Birdcage
  • Tower
  • Temporary roof
  • Cantilevered
  • Gantry Scaffold
  • Loading Bay
  • Staircase
  • Adaption
  • Other

• Description of the scaffold/works

• Please provide Height(H) Width(W) and Length(L) of the scaffold.

• No. of Boarded Lifts

• Hire Period

• TG20 Compliant

  Yes

  No

Tie Details

• Is Pull Test required prior to handover of the scaffold?

  I Confirm

  No

• Is the scaffold freestanding?

  Yes

  No

• Tie type

  Physical

  Mechanical

  Other

• Description of the tie? Box tie, Lip tie, Steel Clamps, Anchor Type

• Description of the tie? Box tie, Lip tie, Steel Clamps, Anchor Type

• Description of the tie? Box tie, Lip tie, Steel Clamps, Anchor Type

• Tie Quantity (Enter 0 if N/A)

• Qty Tested (Enter 0 if N/A)

• Load Tested (kN) (Enter 0 if N/A)

Cuts, Waste of Materials

• How many boards have been cut (Enter 0 if N/A)

• How many scaffolding components have been cut? Beams, Tubes etc. (Enter 0 if N/A)

Access Requirements

• Are there access requirements

  Yes

  No

• Please specify access requirements

• Have the detailed requirements of the Work at Height Regulations 2005<br>and any other relevant legislation been complied with?

  Yes

  No

• Please state the reason for non-compliance

Further Actions

• Is any further actions considered necessary?

  Yes

  No

• Please describe further actions necessary.

Load details

• Number of working lifts?

• Load kN/m2

• Number of inside boards (Type 0 if N/A)

• Load to inside boards

  0.73 kN

  None Loading

• Has the scaffold been designed to take sheeting/debris netting (or<br>wind sails)?<br>

  Yes

  No

Compliance

• The scaffold has been completed in accordance with the client's requirements.<br>It is structurally sound and should only be used and loaded in accordance with this Handover Certificate.<br>

  I Confirm

  No

• Please provide further details.

Signatures

• Signature on the behalf of the Scaffold Contractor

  Sign

• Name and Position of the Client's Representative

• Signature on the behalf of the Client/Contractor

  Sign

User Responsibilities

• Users Responsibilities
  Scaffolding is safe a long as you comply with the regulations and the following:
  ALWAYS
  Ensure the scaffold supplied meets with your minimum requirements/specification.
  Ensure the scaffold duty and loading above is in accordance with your specification.
  Carry out and record statutory inspections in accordance with the WAHR*.
  Keep a copy of the report at your site during the construction work and thereafter at your offices for 3 months.
  Check scaffold before use.
  Use suitable warning signs for incomplete or unsafe scaffolds.
  Spread the load ­ instruct users on maximum loading specified.
  Use suitable loading towers.
  Report any damage to scaffold materials (erected or not) to the scaffold contractors.
  Scaffolding is very dangerous if abused so ensure you never do the following:
  NEVER
  Remove Ties.
  Remove, adjust, alter or modify any part of the scaffold.
  Overload the scaffold.
  Allow digging under or near the scaffold.
  Add sheeting or netting unless the scaffold has been designed for it.
  Forklift loads directly on to access scaffold.
  WAHR* : In order to comply with Regulation 12 of the work at height Regulations 2005, this scaffold must be inspected before first use, every 7 days,
  and after any event likely to have affected its strength or stability and any substantial addition, dismantling or other alteration. In order to comply with
  Regulation 12 (7), particulars of each inspection must be recorded in a Report or inspection. It is also the responsibility of every employer under
  Regulation 3 to ensure that the requirements of the Regulation which apply to their employees are complied with