SC03 Scaffold Inspect Checklist

• * SRC (Scaff) No.

• Area

• Working on

• Work Order number

• * Audit Reason - Completion of

  Erect

  Modify

  Inspect Due

• * Project / Job Name

• Client department

  Select

• TQ Required

  Yes

  NA

• TQ Number

• Personnel

• * Conducted on

  Date

• * Prepared by

• * Location
  Address

• Document No.

SCAFFOLD ID

• Client Name

• * Scaff Name (Equip/Location)

• Scaffold Type

  Select

• ellaborate

• Have you installed Visual rating information for end user (signage - MUST COMPLIANCE)

  Yes

  N/A

  No

CHECKPOINTS (ALL *)

• * 1. Access

  Safe

  At Risk

  N/A

• * 2. Decking

  Safe

  At Risk

  N/A

• * 3. Standards

  Safe

  At Risk

  N/A

• * 4. Handrails

  Safe

  At Risk

  N/A

• * 5. Load Points

  Safe

  At Risk

  N/A

• * 6. Load on Scaff

  Safe

  At Risk

  N/A

• * 7. Bracing

  Safe

  At Risk

  N/A

• * 8. Ties

  Safe

  At Risk

  N/A

• * 9. Lashing

  Safe

  At Risk

  N/A

• * 10. Anchor Points

  Yes

  NA

• Have you installed Visual rating information for end user (signage - MUST COMPLIANCE)

  Yes

  N/A

  No

• * 11. Scafftag

  Select

COMMENTS / SCAFFOLD PHOTOS / DRAWINGS

• * Scafftag Updated (MANDATORY PHOTO OF SCAFFTAG)

  Media

• * Photo(s) of Scaffold

  Media

• Sketch any areas that may need attention.

  Media

• * Were any items answered 'At Risk'? If Yes, add Note & Photo. (& Action if required).

  Yes

  NA

• * Scaffold Status

  Correct

  Minor Adjustments

  Major

FINAL INSPECTION SIGN OFF

• Has fire risk been observed and controlled for start up

  Pass

  Fail

  N/A

• Scaffold interaction controlled in the proximity to Surface Mobile equipment

  Pass

  Fail

  N/A

• Have secured or removed ANY potential dropped objects

  Yes

  N/A

  No

• * Supervisor - Name & Sign

  Sign

• Leading hand - Name & Sign

  Sign

• IF SCAFFOLD IS OUT OF SERVICE OR NON COMPLIANT, ACCESS IS TO BE REMOVED OR BLOCKED