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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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.