Information

  • Document No.

  • Job Site/Number

  • Conducted on

  • Weather Conditions

  • Prepared by

Section 1

  • Has the scaffold been erected under the supervision of the competent person?

  • Are base plates being used?

  • Are mudsills properly installed?

  • Is scaffold plumb and level?

  • Have scaffold components been inspected for damage?

  • Are scaffold components from different manufacturers being used?

  • Has the competent person deemed this acceptable?

  • Are all cross braces in place?

  • Is safe access/egress provided?

  • Are any sources of electricity within 10 feet of the scaffold?

  • Are scaffold planks made of scaffold grade lumber and in good condition?

  • Are planks covered with paint or any opaque finishes?

  • Are all working areas fully planked?

  • Are scaffold platforms at least 18 inches wide?

  • Do scaffold planks extend over the centerline of the support at least 6 inches and no more than 12 inches unless cleated or restrained?

  • When scaffold planks are abutted to form a longer platform, does the overlap occur over supports?

  • Is the overlap at least 12 inches unless nailed together or otherwise restrained?

  • Where platforms change direction, are planks properly supported?

  • Is the scaffold able to support its maximum intended load?

  • Has the scaffold reached a height requiring it to be tied into the structure?

  • Is the distance between the front edge of scaffold platform and the face of work 14 inches or less (18 inches for plastering and lathing)?

  • Is fall protection being provided at 6 feet for employees working on the scaffold?

  • Where guardrails are used, are they installed along all open sides and ends of platforms?

  • Is the toprail installed between 38 and 45 inches and capable of supporting 200 lbs?

  • Is the midrail installed halfway between the toprail and the platform and capable of supporting 150 lbs?

  • If crossbraces are used to replace a midrail or toprail, are the end points at each upright 48 inches apart or less?

  • Is fall protection feasible for employees erecting or dismantling scaffodl?

  • If personal fall arrest systems are being used, will the anchorage support 5000 lbs?

  • Are employees working below protected from falling objects by use of toeboards, netting, etc...?

  • If toeboards are used, are they at least 3.5 inches high?

  • Do toeboards have a 1/4 inch or less clearance between the bottom of the toeboard and the walking or working surface?

  • Please describe in detail any items above not checked as acceptable and the corrective action taken:

  • 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.