LCB Scaffold Inspection Report

• Site conducted

  Select

• Client

• Location
  Address

• Conducted on

  Date

• Prepared by

• 1. Name and address of person for whom inspection was carried out

• 2. Location and description of place of work or work equipment inspected

• 3. Matters which give rise to health and safety risks

  Safe

  At Risk

  N/A

• 4. Is the scaffold safe to use ?

  Yes

  No

  N/A

• 5. If not, name of person informed unsafe to use

• 6. Details of any action taken as a result of matters identified in section 3.

• 7. Details of any further action required

• 8. Name and position of person receiving the report

• Site Address:

Footings

• Soft & uneven

  Safe

  At Risk

  N/A

• Base Plates

  Safe

  At Risk

  N/A

• Sole Boards

  Safe

  At Risk

  N/A

• Undermined

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Bracing

• Façade & ledger

  Safe

  At Risk

  N/A

• Some missing

  Safe

  At Risk

  N/A

• Loose

  Safe

  At Risk

  N/A

• Wrong fittings

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Boarding

• Damaged Boards

  Safe

  At Risk

  N/A

• Trap boards

  Safe

  At Risk

  N/A

• Incomplete

  Safe

  At Risk

  N/A

• Insufficient

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Standards

• Not Plumb

  Safe

  At Risk

  N/A

• Joined in same bay

  Safe

  At Risk

  N/A

• Loose

  Safe

  At Risk

  N/A

• Damaged

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Couplings

• Wrong fittings

  Safe

  At Risk

  N/A

• Loose

  Safe

  At Risk

  N/A

• Damaged

  Safe

  At Risk

  N/A

• No check couplers

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Guard Rails & Toe Boards

• Wrong height

  Safe

  At Risk

  N/A

• Some missing

  Safe

  At Risk

  N/A

• Loose

  Safe

  At Risk

  N/A

• Damaged

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Ledgers

• Not level

  Safe

  At Risk

  N/A

• Joined in same bay

  Safe

  At Risk

  N/A

• Loose

  Safe

  At Risk

  N/A

• Damaged

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Ties

• Some missing

  Safe

  At Risk

  N/A

• Loose

  Safe

  At Risk

  N/A

• Damaged

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

Ladders

• Insufficient height

  Safe

  At Risk

  N/A

• Not tied

  Safe

  At Risk

  N/A

• Damaged

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

• Satisfactory

  Yes

  No

  N/A

• Comments:

• Inspected by;

• Position;

• Signature;

  Sign

• Scaffold Status

  Compliant

  Non-Compliant

  N/A

• Office Compliance- Please assign action to complete office compliance

  Yes

  No

  N/A