Kallam Darby

Scaffold

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Title Page

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

X=Not applicablr 0=Non-compliance 1=insufficient 2=acceptable 3=excellent
Scaffold has been inspected by a competent person for that shift.
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Scaffold has proper ladder access.
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Scaffold platform is fully planked (.451 B1).
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Platform is free of excess tools, material or debris.
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Scaffold is equipped with toe boards if required.
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Scaffold is not being used as anchor point.
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Scaffold is fully enclosed or 100% tie off is being used.
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Scaffolds are 10' from power lines.
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If any part of the scaffold is damaged it is tagged out and taken out of service.
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Kallam Darby

Scaffold

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