John Houlihan - Handover Form Template

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Item Description

• At the time of accepting handover of this scaffold it becomes the main contractor’s responsibility by law to maintain inspections every 7 days

• Are Rule One to continue weekly inspection:

  Yes

  No

  N/A

• Is there a Scaff Tag being left on the scaffold:

  Yes

  No

  N/A

• The scaffold as described above has been completed in accordance with client requirements. It is structurally sound, complies with Working at Height Regulations 2005 and should only be used in accordance with this Handover Certificate

• Please note the date recorded on this handover will be recorded as the beginning of the hire period

Scaffold Design

• Type Of Design

  TG20 Compliance Sheet

  Full Design

  Manufacturers Instructions

• Is the design at working stage:

  Safe

  Recommendation

  Unsafe

  N/A

• Is the design sufficient for the scaffold erected:

  Safe

  Recommendation

  Unsafe

  N/A

• Is the scaffold compliant with the design:

  Safe

  Recommendation

  Unsafe

  N/A

Loading

• Loading to be One Number Working Lift @

• An additional working lift @ reduced loading @

• Inside board loading @

  0.75kN

Ties

• Are ties fitted on sufficient load bearings fittings:

  Safe

  Recommendation

  Unsafe

  N/A

• Are ties at the correct intervals:

  Safe

  Recommendation

  Unsafe

  N/A

• Are correct ties in use for base material:

  Safe

  Recommendation

  Unsafe

  N/A

• What is the SWL test load of the ties:

• Have the pull test requirements been met:

  Safe

  Recommendation

  Unsafe

  N/A

• Tie Pull Test Evidence:

Footings

• Is there any evidence of sinkage:

  Safe

  Recommendation

  Unsafe

  N/A

• Are standards on base details adequate (base plate, sole board):

  Safe

  Recommendation

  Unsafe

  N/A

Standards

• Are standards Plum within allowance:

  Safe

  Recommendation

  Unsafe

  N/A

• Are standards correctly spaced:

  Safe

  Recommendation

  Unsafe

  N/A

• Are standards correctly staggered:

  Safe

  Recommendation

  Unsafe

  N/A

Ledgers

• Are ledgers plum within allowance:

  Safe

  Recommendation

  Unsafe

  N/A

• Are joints correctly staggered:

  Safe

  Recommendation

  Unsafe

  N/A

Handrail & Toeboards

• Is there a handrail minimum 950mm from the working platform:

  Safe

  Recommendation

  Unsafe

  N/A

• Is there no larger than a 470mm gap between handrails and toe boards:

  Safe

  Recommendation

  Unsafe

  N/A

• Are non-working platform lifts handrailed:

  Safe

  Recommendation

  Unsafe

  N/A

• Are handrails and Toe Boards installed sufficient for purpose of works:

  Safe

  Recommendation

  Unsafe

  N/A

• Is ladder guardrail in place:

  Safe

  Recommendation

  Unsafe

  N/A

Transoms

• Is there a transom minimum of 300mm from the node point:

  Safe

  Recommendation

  Unsafe

  N/A

• Are transoms no greater than 1.2m apart:

  Safe

  Recommendation

  Unsafe

  N/A

Bracing

• Is all bracing connected within 300mm of the node point:

  Safe

  Recommendation

  Unsafe

  N/A

• Is ledger bracing installed at correct intervals:

  Safe

  Recommendation

  Unsafe

  N/A

• Is there sway bracing no more than 6 bays apart:

  Safe

  Recommendation

  Unsafe

  N/A

Access

• Is access installed adequate:

  Safe

  Recommendation

  Unsafe

  N/A

• Are routes to access clear:

  Safe

  Recommendation

  Unsafe

  N/A

• Are adequate safety gates/hatches in place:

  Safe

  Recommendation

  Unsafe

  N/A

• Are ladders 1.050m above the boarded lift:

  Safe

  Recommendation

  Unsafe

  N/A

• Are ladders installed at the correct 1 to 4 angle:

  Safe

  Recommendation

  Unsafe

  N/A

• Is the ladder gap the correct size:

  Safe

  Recommendation

  Unsafe

  N/A

• Are ladders correctly secured:

  Safe

  Recommendation

  Unsafe

  N/A

Platform

• Is the platform adequate for the purpose of works:

  Safe

  Recommendation

  Unsafe

  N/A

• Is the platform safe and gaps kept to a minimum:

  Safe

  Recommendation

  Unsafe

  N/A

• Are the boards in suitable condition:

  Safe

  Recommendation

  Unsafe

  N/A

• Is there no gaps greater than 225mm:

  Safe

  Recommendation

  Unsafe

  N/A

• Are gaps larger than 100mm being managed:

  Safe

  Recommendation

  Unsafe

  N/A

Housekeeping

• Is all spare material cleared:

  Yes

  No

  N/A

• Has sheeting been installed neatly (if applicable):

  Good

  Fair

  Poor

  N/A

• Has the site been left clear of mess:

  Yes

  No

  N/A

Equipment

• Are Gates/Hatches free of damage and in safe working condition:

  Safe

  Recommendation

  Unsafe

  N/A

• Are ladders free of damage and in safe working condition:

  Safe

  Recommendation

  Unsafe

  N/A

• Has lifting operation equipment been left on site:

  Yes

  No

  N/A

• Lifting equipment ID number:

• Is lifting equipment fit for use and installed correctly:

  Safe

  Recommendation

  Unsafe

  N/A

Safety

• Is scaffold compliant with Working at Heights Regs 2005:

  Compliant

  Non-Compliant

  N/A

• Is double boarded installed over doorways and walkways:

  Yes

  No

  N/A

• Is there enough security to keep unauthorised personnel off the scaffold:

  Safe

  Recommendation

  Unsafe

  N/A

• Is there 300mm safe clearance in front of all boiler flues:

  Yes

  No

  N/A

• Is there sufficient protection of tubes and fittings for pedestrians:

  Yes

  No

  N/A

• What is the overall standard of scaffold:

  Good

  Fair

  Poor

  N/A

• Are there any further comments to be made:

• Signature of Rule One representative:

  Sign

• Signature of Main Contractor Representative:

  Sign