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GENERAL

  • Are poles, legs, cross braces or uprights plumb and securely braced to prevent swaying and/or displacement?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Are all brace connections secured?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Are platforms kept within the frame of the scaffold unless stabilized by outrigger frames or equivalent devices?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

WHEELS

  • Are the wheels in good working order?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Are wheel locks present and in use?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Are caster stems or adjustment screws in scaffold legs pinned or otherwise secured?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

MOVING

  • Is scaffold stabilized to prevent tipping during movement?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Are the people moving the scaffold applying force within 5 feet of the base?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • If employees are to remain on scaffold, are ALL of the following conditions being met?

  • Surface is with 3 degrees of level.

  • Surface is free of pits, holes, and obstructions.

  • Height to base width ratio is 2:1 or less.

  • No employee is on any part of the scaffold that extends beyond wheels, casters, or other supports.

  • Employees have been made aware of the scaffold being moved.

PERSONNEL

  • Has the scaffold been erected under the supervision of a competent person?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Name of competent person:

  • Have personnel on platform received scaffold training?

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  • Tag scaffold out of service IMMEDIATELY and contact foreman.

  • Comments:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.