LTC Scaffolding Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Scaffold

• Address of scaffold
  Address

• When was the last scaffolding inspection to the property

  Date

• Who carried out the last inspection

• Is the scaffold on correct base

  Yes

  No

  N/A

• Is the load on the scaffolding (including point loading) within the mfg. max load of this particular scaffold?

  Yes

  No

  N/A

• Have employees who use scaffold been trained by a qualified person to recognize the hazards associated with this type of scaffold and know the performance of their duties related to it?

  Yes

  No

  N/A

• Have employes who erect, disassemble, move, operate, repair, and inspect the scaffold been trained by a competent person to recognize the hazards associated with this type of scaffold and with the performance of their duties related to this scaffold per 29 CFR 1926 sub part (l)

  Yes

  No

  N/A

• Are mud sills level, sound, and rigid?

  Yes

  No

  N/A

• Is max load capacity of this type known and communicated to all employees?

  Yes

  No

  N/A

• Have the scaffold ties been tested and are records present on site

  Yes

  No

  N/A

• Has the scaffold been tied every 4m2 or as otherwise stated by design drawing

  Yes

  No

  N/A

• Has the scaffold been erected in accordance with TG20:08 and SG4:10

  Yes

  No

  N/A

• Have ladders been secured correctly and safely

  Yes

  No

  N/A

• Are locking pins still safely in place

  Yes

  No

  N/A

• Is the scaffold plumb, square and rigid ( if there is been slipping of tube and fitting, please provide details)

  Yes

  No

  N/A

• Are scaffold boards secured correctly and in place

  Yes

  No

  N/A

• Has scaffold been erected in accordance with design drawing

  Yes

  No

  N/A

Fall protection

• Are work platforms fully decked?

  Yes

  No

  N/A

• Are all required guardrails, mid rails, and toe boards in place?

  Yes

  No

  N/A

• Please provide a photo

  Media

• Is there safe access to all work platforms?

  Yes

  No

  N/A

• Is fall protection required?

  Yes

  No

  N/A

Sign off

• Comments

• Auditor

  Sign

• Senior Manager

  Sign