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?

  • If employees working on the scaffold are exposed to falling objects, are they being protected by use of hardhats, etc...?

  • 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

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