Matrix Scaffold Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Scaffold vicinity

• 1.1. Has Public protection been provided and adequate.

  Safe

  At Risk

  N/A

• 1.2. Are there safe guards in place to prevent exposure to power lines?

  Safe

  At Risk

  N/A

• 1.3. Is scaffold protected from contact by moving vehicles?

  Safe

  At Risk

  N/A

• 1.4. Do crane operations interfere with scaffolding operations?

  Safe

  At Risk

  N/A

• 1.5. Are there controls in place for any hazardous materials?

  Safe

  At Risk

  N/A

• 1.6. Are scaffolds erected a safe distance away from trenches or excavations?

  Safe

  At Risk

  N/A

• 1.7. Other

  Yes

  No

  N/A

2. Supporting Structure

• 2.1. Is the supporting structure in good condition?

  Safe

  At Risk

  N/A

• 2.2. Are there sufficient controls to prevent deterioration of the supporting structure?

  Safe

  At Risk

  N/A

• 2.3. Has the supporting structures ground bearing been inspected?

  Safe

  At Risk

  N/A

• 2.4. Other

  Yes

  No

  N/A

3. Sole boards and base plates

• 3.1. Are there sufficient baseplates?

  Safe

  At Risk

  N/A

• 3.2. Are the baseplates designed for the scaffold in use?

  Safe

  At Risk

  N/A

• 3.3. Are the sole boards positioned correctly?

  Safe

  At Risk

  N/A

• 3.4. Are the sole boards of adequate condition?

  Safe

  At Risk

  N/A

• 3.5. Are the soleboards secure?

  Safe

  At Risk

  N/A

• 3.6. Other

  Yes

  No

  N/A

4. Scaffold structure

• 4.1. Are the standards bearing firmly? (not floating)

  Safe

  At Risk

  N/A

• 4.2. Are the standards plumb (or as designed)?

  Safe

  At Risk

  N/A

• 4.3. Are the longitudinal standard spacings as per manufacturers design?

  Safe

  At Risk

  N/A

• 4.5. Are the joints locked or pinned?

  Safe

  At Risk

  N/A

• 4.16. Is the bracing adequate and as per the manufacture?

  Safe

  At Risk

  N/A

• 4.17. Is the scaffold stable?

  Safe

  At Risk

  N/A

• 4.18. Are the cross braces or horizontal bar braces locked and secure?

  Safe

  At Risk

  N/A

• 4.19 Other

  Yes

  No

  N/A

5. Platforms

• 5.1. Are catch platforms, netting, or toe boards correctly positioned?

  Safe

  At Risk

  N/A

• 5.2. Are the platforms and supporting scaffold constructed for the appropriate duty of live loads?

  Safe

  At Risk

  N/A

• 5.3. Are the platform dimensions suitable for the intended work?

  Safe

  At Risk

  N/A

• 5.4. Are the platforms correctly constructed?

  Safe

  At Risk

  N/A

• 5.5. Is the edge protection installed?

  Safe

  At Risk

  N/A

• 5.6. Are planks secured against wind uplift and dislodgement?

  Safe

  At Risk

  N/A

• 5.7. Other

  Yes

  No

  N/A

6. Access and egress

• 6.1. Is there safe access and egress to every scaffold platform?

  Safe

  At Risk

  N/A

• 6.2. Are temporary stairways correctly installed?

  Safe

  At Risk

  N/A

• 6.3. Are portable ladders of an industrial grade, serviceable and correctly installed?

  Safe

  At Risk

  N/A

• 6.4. Are access ways and access platforms correctly installed?

  Safe

  At Risk

  N/A

• 6.5. Are access and egress points suitable for emergency service response?

  Yes

  No

  N/A

• 6.6 Other

  Yes

  No

  N/A

7. Containment sheeting

• 7.1. Is the scaffold adequate for wind loading if applicable?

  Safe

  At Risk

  N/A

• 7.2. Are the fixing ties installed correctly?

  Safe

  At Risk

  N/A

• 7.3. Are there any rips, tears or openings in the containment sheeting?

  Safe

  At Risk

  N/A

• 7.4. Are the overlap joints arranged to prevent materials from allying outside scaffold?

  Safe

  At Risk

  N/A

• 7.5 Other

  Yes

  No

  N/A

8. General fitness for purpose

• 8.1. Is there adequate provision for material handling?

  Safe

  At Risk

  N/A

• 8.2. Are the clearances between the scaffold and adjacent structures secure?

  Safe

  At Risk

  N/A

• 8.3. Is there adequate protection from falling debris?

  Safe

  At Risk

  N/A

• 8.4. Has the scaffold been adequately designed to support all attachments?

  Safe

  At Risk

  N/A

• 8.5. Are all approaches and platforms effectively lit?

  Safe

  At Risk

  N/A

• 8.6 Other

  Yes

  No

  N/A

9. Mobile scaffold

• 9.1. Is the supporting surface hard and flat?

  Safe

  At Risk

  N/A

• 9.2. Is the area of operation free of floor penetrations, powerlines and other hazards?

  Safe

  At Risk

  N/A

• 9.3. Are the castor wheel locks in working order? They should be locked at all times, except during movement of the scaffold.

  Safe

  At Risk

  N/A

• 9.4 Other

  Yes

  No

  N/A

Comment and sign off by inspecting Matrix person

• Additional comments by inspecting person

• Name and occupation of inspecting person signing off

  Sign