Matt Crozier

Scaffold Hand-Over Certificate - Southern Safety SolutioNZ

The scaffold hand-over certificate releases the scaffold(s) to the client. The scaffold(s) have been inspected by the client and has been erected to the client’s requirements. All scaffolds have been erected as per the requirements of the Good Practice Guidelines for Scaffolding in New Zealand. The client undertakes to control the use, and users of the scaffold structure(s) while under their control as required by the Health and Safety at Work Act 2015 (HSWA), and the Health and Safety in Employment Regulations 1995 (HSE Regulations).

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Title Page

Client Name
Location
Scaffold Description
Comments: (special conditions)
Authorised foreman/client:
Add signature
Select date
Scaffolding representative:
Add signature
Select date

Note: Scaffolding over 5.0 m high is notifiable work and the erection/dismantling or alterations including the movement of planks, can only be carried out under the supervision of a Scaffolder holding a current Certificate of Competency.
Has WorkSafe been notified? This needs to be done for any work where a scaffolder is exposed to a fall greater than 5m.
Number of lifts fully planked with full edge protection:
Ladder/stair access bays to all working lifts:
Screening Installed:
Scaffold register locations
Scaffold Duty Type
Useable lifts per bay
Limitations
Commentary

Matt Crozier

Scaffold Hand-Over Certificate - Southern Safety SolutioNZ

Use this Template

Print as PDF

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.