Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Name
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Check Out/Check In
- Check Out
- Check In
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Date/Time
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Which Scaffold?
- Standard Scaffold (red)
- Perry Scaffold (yellow)
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How many levels of scaffolding are you taking?
- 1
- 2
- 3
- 4
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How many platforms pieces are you taking?
- 1
- 2
- 3
- 4
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Braces
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Wheels
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Pins
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Safety Rails (if applicable)
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Outriggers (if applicable)
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Any visible damage or maintenance needed?
- Yes
- No
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Description of any Damage or Maintenance needed
