Title Page
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Conducted on
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Prepared by
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Location
Client Responsibilities
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1. Once the scaffold structure has been inspected and handed over to the client it is the responsibility of the client to ensure that mandatory inspections are performed in accordance with the Work at Height Regulations 2005.
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2- It is the duty of the user (the client) to ensure that the scaffold structure is used and maintained in a safe manner.
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3- This scaffold must be inspected at intervals not exceeding seven days and any after any event that may affect its safety.
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4- The scaffold must not be modified by third party without authorisation from Embassy Site Services Management
CUSTOMER USE OF A SCAFFOLD
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Certificate number:
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Scaffolding Contractor: Embassy Site Services -Mardyke Farm, Ship Lane, Aveley, Essex. RM19 1YX
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Client name and address:
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Project reference:
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Location:
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Scaffold reference:
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Drawing/design standard:
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Date and time:
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Scaffold Specification
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Description of the section handed over:
Important Safety Information
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Working Platform Max loading kN/m2
- Load Class 3 General Purpose- Max Loading 2kn/m2(200kg/m2)
- Load Class 4 Heavy Duty- Max Loading 3kn/m2(300kg/m2)
- Special Design
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Number of working Platforms
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Inside board loading:
- Inside Boards Max Loading 0.75kn/m2(75kg/m2)
- Special Design
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Permitted cladding:
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None
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Brick/guards
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Debris netting
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Sheeting
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Method of tying:
Have the tie been tested?
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Handover :The scaffolding as described above has now been completed in accordance with client requirements. It is structurally sound and should only be used and loaded in accordance with this handover certificate
Have the requirements of the Work at height Regulations 2005 and any other relevant legislation been complied with?
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The reason for non-compliance is:
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Details of any further action considered necessary:
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Acceptance
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Signature on behalf of the scaffolding contractor
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Acceptance on behalf of the client
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Name:
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Signature:
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Position:
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Date:
PRIOR TO DISMANTLE
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Before dismantling a scaffold structure, which has previously been handed over to the user (client), the structure should be thoroughly inspected to identify any defect likely to cause a potential safety risk to workers undertaking the dismantling.
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Any defects must be rectified before dismantling commences.
And /or Certificate despatched to the client
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post
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fax
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email
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Date:
