Next Energy Scaffold Handover Certificate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• 1. Once the scaffold structure has been inspected and handed over to the client it is the responsibility of the client to ensure that mandatory inspections are performed in accordance with the Work at Height Regulations 2005.

• 2- It is the duty of the user (the client) to ensure that the scaffold structure is used and maintained in a safe manner.

• 3- This scaffold must be inspected at intervals not exceeding seven days and any after any event that may affect its safety.

• 4- The scaffold must not be modified by third party without authorisation from the Contractor who errected the Scaffold

• Certificate number:

• Scaffolding Contractor:

• Client name and address:

• Project reference:

• Location:

• Scaffold reference:

• Drawing/design standard:

  NASC TG20 Compliance Sheet

  Special Design

  Engineer Input Required

  Not Applicable

• Date and time:

  Date

• Scaffold Specification

• Description of the section handed over:

  Full Envelop

  Front Elevation

  Rear Elevation

  Side Elevation

Important Safety Information

• Working Platform Max loading kN/m2

  Select Load Class 3 General Purpose- Max Loading 2kn/m2(200kg/m2) Load Class 4 Heavy Duty- Max Loading 3kn/m2(300kg/m2) Special Design

  • Load Class 3 General Purpose- Max Loading 2kn/m2(200kg/m2)
  • Load Class 4 Heavy Duty- Max Loading 3kn/m2(300kg/m2)
  • Special Design

• Number of working Platforms

• Inside board loading:

  Select Inside Boards Max Loading 0.75kn/m2(75kg/m2) Special Design

  • Inside Boards Max Loading 0.75kn/m2(75kg/m2)
  • Special Design

• Brick/guards

  Yes

  No

  N/A

• Debris netting

  Yes

  No

  N/A

• Sheeting

  Yes

  No

  N/A

• Method of tying:

Have the tie been tested?

• Handover :The scaffolding as described above has now been completed in accordance with client requirements. It is structurally sound and should only be used and loaded in accordance with this handover certificate

  Yes

  No

  N/A

Have the requirements of the Work at height Regulations 2005 and any other relevant legislation been complied with?

• The reason for non-compliance is:

  Compliant

  Non-Compliant

  N/A

• Details of any further action considered necessary:

• Acceptance

  Yes

  No

  N/A

• Signature on behalf of the scaffolding contractor

  Sign

• Acceptance on behalf of the client

  Yes

  No

  N/A

• Name:

• Signature:

  Sign

• Position:

• Date:

  Date

And /or Certificate despatched to the client

• post

  Yes

  No

  N/A

• email

  Yes

  No

  N/A

• Date:

  Date