Title Page
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Site conducted
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Plant/Area:
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Employee/Contractor Name:
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Conducted on
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Prepared By:
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Line Manager:
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Location
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Does scaffold builders have tool bags or pouches to keep their tools secure so it does not fall from heights?
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Is the required barricading in place and in a good condition where scaffold erection or dismantling is taking place?
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Is the condition of scaffold material acceptable? (obvious rust and other signs of deterioration)
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Has a secure 100% tie off point been used when utilising a safety harness? (Tie-off point above shoulder height?)
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Are safety harnesses fit for use? (E.g. hooks opening and closing properly; Shock absorber intact etc.)
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Is the life line and/or safety harness equipment inspected and in a good condition? (Hooks opening and closing properly, shock absorber intact on the harness etc.)
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Where a weight bearing scaffold footplate is located on a structure or part of a structure, can it support the weight of the scaffold as well as the intended load?
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Is the scaffolding tagged accordingly when it is still being built or broken down? Note: When scaffold is being built / broken down, it is red tagged – is sufficient fall protection provided?
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Is plant equipment, cable racks or process lines utilised as support for scaffolds?
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Are a ladder installed for safe access to the scaffold?
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Has the scaffold been inspected in the last 7 days by the scaffold supervisor / inspector?
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Comments: Where deviations have been noted, indicate the corrective action taken. Also report the matter to the supervisor. Look for other hazards that might have been missed in the risk assessment.
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Auditor's Signature
