Information

  • Document No.

  • Project Name

  • Project Number

  • Conducted on

  • Prepared by

  • Location:

Work Schedule

  • From

  • To

Weather Conditions

Precipitation

  • Rain

  • Snow

  • Weather Conditions:

Temperature

  • High

  • Low

Scaffolding Size

  • Ft. Width

  • Ft. Long

  • Any scaffold over 125'-0" in height MUST be designed by a Registered Professional Engineer

Check List

  • Does Hogan have a copy of the C.P's card responsible for this scaffold

  • Has the C.P. tagged the scaffold safe to use before workers start

  • Is competent person supervising erection, moving, dismantling or alteration of scaffold

  • Has the crew received required training

  • Are all the scaffold components free from defects

  • Are the foot plates on sound, solid material

  • Have mud sills / base plates / screw jacks been installed

  • Has the potential for electrical hazards been assessed and controlled

  • Are the frames leveled and plumbed

  • Is the scaffold tied to the building or another secured scaffold at both ends, (4x the base width, & every 30' horizontal)

  • Are all cross braces installed properly

  • Are the outrigger brackets being used for workers only

Scaffold Platform Inspection

  • Has planking been Installed so that gaps between planks are not more than 1"

  • Are wood planks scaffold grade stamped

  • Are the planks overlapping supports and ends of scaffold frames by at least 6"

  • Are the aluminum hooks on hook-on scaffold planks in good condition

  • Is the front edge of platform properly spaced from work face (most 14"; plaster-18")

  • Have planks been inspected for damage and damaged planks removed

  • Is platform fully planked or decked

Fall Protection (Six - 6')

  • Are materials being lifted and lowered properly

  • Are all platform ends and material staging areas guarded properly

  • Top-rail, mid-rail and toe-boards installed ("X" bracing cannot be both top & mid rail)

Scaffold Access

  • Are ladders installed per manufacture recommendation

  • Are ladders tied - off at the top and bottom and in good condition

  • Are ladders extended 36" above the platform

  • Is scaffold access within 14" horizontally & 24" vertically of access surface

  • Other Safety Concerns:

  • Competent Person Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.