Mission Critical Safety 3rd Party Supported Scaffold Inspection

• Client / Site

• Location
  Address

• Conducted on

  Date

• Subcontractor

• Location of Scaffold at project

• Are scaffolds and their components inspected daily by competent person

  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

• 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

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

  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

• Is the scaffold on base plates?

  Yes

  No

  N/A

• Add media

  Media

• Are mud sills level, sound, and rigid?

  Yes

  No

  N/A

• Is the scaffold plumb and square?

  Yes

  No

  N/A

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  Media

• Are 4:1 scaffolds guyed or secured as required

  Yes

  No

  N/A

Fall protection

• Is fall protection required?

  Yes

  No

  N/A

• Are all employees using 100% tie off?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Add media

  Media

• Is there safe access to all work platforms?

  Yes

  No

  N/A

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  Media

• Are work platforms fully decked?

  Yes

  No

  N/A

• Add media

  Media

Sign off

• Comments

• On site representative

  Sign

• Auditor

  Sign