Title Page
PERSONNEL
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Has the scaffold been erected under the supervision of a competent person?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Name of Competent Person:
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Have personnel completed scaffold training?
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Inform foreman and conduct scaffold class prior to allowing access. Notify Division Safety Manager.
BASE SECTION
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Is the scaffold set on mud sills, base plates, or other adequate firm foundation?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are the footings capable of supporting the loaded scaffold without settling or displacement?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Is the scaffold being supported by unstable objects?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Is the frame plumb, level and braced to prevent swaying and displacement?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
STRUCTURE
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Is the scaffold and associated components capable of supporting its own weight plus 4 times the maximum intended load?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Is cross-bracing in place?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are all brace connections secured to prevent dislodging?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are frame components joined together vertically by coupling/stacking pins or other equivalent means?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are all components from the same manufacturer and not "mixed & matched"
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Tag scaffold out of service IMMEDIATELY and inform foreman.
ACCESS
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Are employees using cross bracing for access?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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What is being used to access the scaffold?
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Are hook-on and attachment ladders specifically designed for use for this type of scaffold?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are portable, hook on, and attachment ladders positioned so they do not tip the scaffold?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Is the bottom rung of the ladder not more than 24" above the surface?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are the rungs at least 11.5" wide?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Is the vertical spacing of rungs uniform and not more than 16.75"?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Do access stairs have slip-resistant treads on all steps and landings?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Do access stairs have steps at least 16" wide
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Are access stairs equipped with rest intervals every 12 vertical feet?
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Tag scaffold out of service IMMEDIATELY and inform foreman.
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Is the frame specifically designed as a ladder rung?
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This frame cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Are the rungs uniformly spaced, at least 8" wide, with a maximum vertical spacing of 16.75"?
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This frame cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is there a top rail and mid rail present on each side of the stairway?
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Is the top rail also capable of serving as a hand rail (strong enough for hold a person from falling if they grasp it)?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Are the top/hand rails smooth to prevent snags/lacerations?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Are the ends of rails constructed so they do not protrude out and create a snag hazard?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is there at least 3" of space between top/hand rails and other objects?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is there a vertical distance of 28"-37" from the top of the top/hand rail to the forward edge of the tread?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is there a landing platform at least 18" x 18" at each level?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Are the steps at least 18" wide between the rails?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Do treads and landings have slip-resistant surfaces?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Are stairs installed at angles between 40 and 60 degrees from horizontal?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is the height of the risers uniform to within 1/4 "?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is the depth of the risers uniform to within 1/4 "?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
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Is the adjacent structure within 14" (horizontally) and 24" (vertically) from the scaffold?
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This cannot be used for access. A portable, hook-on, or attachment ladder should be considered for access.
FALL PROTECTION
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Are employees working 6' or more above a lower level protected from falling?
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Remove employees from hazard IMMEDIATELY. Inform foreman. Notify Division Safety Manager.
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What type of fall protection is being used?
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Is the top edge of the scaffold top rail between 36" and 45"?
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Is the top rail capable of supporting at least 200# of downward/outward force?
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Is cross bracing serving as a guard rail?
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Is the height of the cross bracing between 38" and 48" (top rail) or 20" and 30" (mid rail)?
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Remove employees from hazard IMMEDIATELY. Inform foreman. Notify Division Safety Manager.
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Are the rails within 9.5" of and along at least one side of the walkway?
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Are they installed along all open sides and edges of platforms?
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Is the PFAS attached by lanyard to a vertical lifeline, horizontal lifeline or scaffold structural member?
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NOTE: if horizontal lifelines are used, they must be attached to two or more structural members of the scaffold.
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
PLATFORM
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Is the platform constructed of manufactured platforms or timber planks?
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Ensure scaffold grade timber is used and is free of splits.
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Is the platform capable of supporting its own weight plus four times the maximum intended load?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Is the platform overloaded with personnel or materials?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Is the platform fully planked or decked ?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Are platforms at least 18" wide?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager. NOTE: Narrower platform are allowed with approval in writing from the Division Safety Manager.
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Is the platform free of slip/trip/fall hazards?
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If objects creating the hazard cannot be removed immediately, Remove employees from hazard IMMEDIATELY and notify foreman.
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Are platforms cleated or otherwise restrained at each end? If not, do they overlap the centerline support by 6" - 12"?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Where platforms are overlapped to create a long run, does the overlap occur only at supports, and are the overlaps at least 12" long unless otherwise restrained to prevent movement?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Is falling object protection (toe board, debris nets, canopy) in place
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Remove employees from hazard IMMEDIATELY and notify foreman.
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What type of protection is in use?
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Are toe boards at least 3.5" high and capable of withstanding 50 pounds of force?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Is debris net or canopy strong enough to withstand the impact of objects falling into it?
STABILITY
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Is the scaffold at a height which exceeds 4 times the width of the base? (4:1)
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Are guys/braces installed to both the inner and outer scaffold legs?
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Remove employees from hazard IMMEDIATELY and notify foreman. Notify Division Safety Manager.
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Are storms or high winds present?
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Remove employees from hazard IMMEDIATELY and notify foreman.
ELECTRICAL HAZARDS
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Is scaffold within 10' of power lines?
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Are lines de-energized or covered with protective coatings?
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Remove employees from hazard IMMEDIATELY and notify foreman.