Title Page
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Client
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Site Address
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ANG No
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Date
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 the Contractor who errected the Scaffold
CUSTOMER USE OF A SCAFFOLD
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Location and Scaffold reference (Plot No or Tag No)
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Drawing/design standard: ( If Design Please Supply Drawing Number)
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Date and time:
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Description of the section handed over:
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Picture of Scaffolding 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
- Load Class 1 Very Light Duty- Max Loading 0.75kn/m2(75kg/m2)
- Load Class 2 Light Duty- Max Loading 1.50kn/m2(150kg/m2)
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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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Brick/guards
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Debris netting
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Sheeting
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Type of Access and Egress
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Method of tying
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Total Number of Ties
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Number of Ties Tested (Note: Test a Minimum of 3 Ties and at Least 5% of Total Job)
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Ties Tested Too
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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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:
And /or Certificate despatched to the client
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Email
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Date:
