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Site conducted
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Conducted on
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Prepared by
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This checklist is to be utilised at completion of all scaffold lifts/modifications that occur on Melisi Projects construction sites. It is the Site Manager and/or Safety Administrators responsibility to complete this form and sign off along with the Scaffolding Supervisor before they leave site to endorse the scaffold is left in a safe and compliant manner. If there is any non-compliance with the scaffold that section or all the scaffold if necessary is to be tagged out of service (exclusion zone/bunted off) until these issues are rectified and this form is signed off by both Melisi Projects and Scaffolder representative. Hire charges will not commence until scaffold has been erected in a safe and compliant manner. Any non-compliances are to be noted and may incur a charge/back charge until rectified as per scaffolding contract. If the scaffold is left incomplete at the end of a working day, it is the scaffolders responsibly to exclude all personnel from accessing the scaffold until its completion and this form has been signed off by both Melisi Projects and scaffolder.
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The scaffolder/s have provided SWMS and they are signed on to by all workers
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The scaffold has been erected on solid foundations and sole boards used where required
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Is there an adequate face bracing (zig zag)
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All the handrails and mid-rails have been installed
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All toe boards are in place
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Are all lap boards lashed or secured
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The gaps between the scaffold platforms and scaffold platform to building edge/face are 225mm (horizontal) or less
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The gaps between the hop-ups/decks and building floor are 300mm (vertical) or less
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The working deck is clear of materials and debris (minimum safe access is 450mm wide)
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The load capacity/duty of the scaffold is adequate for the work being conducted. (As per compliance tag)
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The scaffolder/s have relevant license to perform high risk (scaffolding) work and have provided ticket via Altora
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Scaffold tag is present (compliant with scaffold requirements) and signed off by scaffolder
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Public protection been provided (perimeter fencing)
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Is there adequate and safe entry/exit to scaffold platforms (stairs)
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All excess scaffold materials have been left neat and do not present as a hazard/housekeeping issue
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All loading bays have been built to plan and are adequate for what is required to be loaded on
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Where plywood sheets are utilized to cover gaps between scaffold bays, gaps must be less than 500mm. (Ply must be 17mm thick minimum)
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All scaffolders materials and pallets have been removed from scaffold
Scaffold Compliance Sign Off
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Summary of Inspection (List of non-compliances if any)
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Sign below so Melisi Projects and scaffold contractor both agree that all the above information is correct and true. If there are non-compliances listed above, another sign off sheet will be required and attached to this form once the non-compliances are rectified
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Melisi Projects Supervisor/Manager
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Scaffold Supervisor/Representative
