SCAFFOLD HANDOVER - duplicate

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Load rating

• Company

• Floor Level

• Handover or Monthly

Scaffold vicinity

• Scaffold Vicinity

  Yes

  No

  N/A

• Sufficient public protection been provided?

  Yes

  No

• Sufficient safeguards against electric power lines been provided?

  Yes

  No

• Sufficient control over vehicle movement?

  Yes

  No

• Sufficient control over crane operation

  Yes

  No

  Not Applicable

• Sufficient controls over the storage, handling and use of hazardous substances?

  Yes

  No

  N/A

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  Media

Base

• Base

  Yes

  No

  N/A

• Are there sufficient sole plates?

  Yes

  No

• Sole plates of suitable material and in a serviceable condition

  Yes

  No

• Sole plates/ base plates secure?

  Yes

  No

• Are there sufficient base plates?

  Yes

  No

• Are the base plates of the appropriate type?

  Yes

  No

• Are the base plates serviceable and of suitable dimensions?

  Yes

  No

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  Media

Scaffold Structure

• Scaffold Structure

  Yes

  No

  N/A

• Standards bearing firmly?

  Yes

  No

• Standards plumb (or as designed)?

  Yes

  No

• Longitudinal standards spacing a correct?

  Yes

  No

• Transverse standard spacing a correct?

  Yes

  No

• Joints in standards correctly positioned?

  Yes

  No

• Standards correctly secured (special duty or hung scaffolds)?

  Yes

  No

• Ledgers level (or as designed)?

  Yes

  No

• Ledgers continuous (or as designed)?

  Yes

  No

• Lift heights correct?

  Yes

  No

  N/A

• Ledgers correctly secured?

  Yes

  No

• Ledger joints correctly positioned ( tube and coupler scaffold)?

  Yes

  No

  N/A

• Joints in ledgers correctly secured ( tube and coupler scaffold)?

  Yes

  No

  N/A

• Sufficient transforms/putlogs?

  Yes

  No

  N/A

• Transforms/putlogs correctly positioned and secured?

  Yes

  No

• Is the bracing adequate?

  Yes

  No

  N/A

• Is the scaffold sufficiently stable?

  Yes

  No

• Have external and internal handrails been installed?

  Yes

  No

  N/A

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Platforms

• Platforms

  Yes

  No

  N/A

• Scaffold have the required number of working platforms?

  Yes

  No

• Working platforms at the required locations?

  Yes

  No

• Catch platforms correctly positioned?

  Yes

  No

• Platforms and supporting scaffold constructed for the appropriate duty live loads?

  Yes

  No

  N/A

• Platform dimensions suitable for the intended work?

  Yes

  No

  N/A

• Adequate edge protection?

  Yes

  No

• Platforms correctly constructed?

  Yes

  No

• Planks secured against wind?

  Yes

  No

  N/A

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Containment sheeting

• Has the scaffold been designed for wind loading on any containment sheeting?

  Yes

  No

  N/A

• Fixing ties secure?

  Yes

  No

• Any rips or tears?

  Yes

  No

  N/A

• Overlap joints satisfactory?

  Yes

  No

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  Media

Supporting structure

• Supporting structure in good condition?

  Yes

  No

• Supporting structure have adequate strength?

  Yes

  No

• Sufficient controls to prevent adverse deterioration of the supporting structure?

  Yes

  No

• All measures to strengthen the supporting structure adequate?

  Yes

  No

• Risk of the supporting structure being overloaded from other sources adequately controlled?

  Yes

  No

  N/A

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Access and Egress

• Access and egress

  Yes

  No

  N/A

• Access and egress to working platforms?

  Yes

  No

• Temporary stairways correctly installed?

  Yes

  No

  N/A

• Portable ladders of an industrial grade, serviceable and correctly installed?

  Yes

  No

  N/A

• Access ways and access platforms correctly installed?

  Yes

  No

  N/A

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General fitness for purpose

• General fitness for purpose

  Yes

  No

  N/A

• Adequate provision for material handling?

  Yes

  No

• Clearances between the scaffold and adjacent structures correct

  Yes

  No

• Adequate protection from falling debris?

  Yes

  No

• Scaffold been adequately designed to support to all attachments?

  Yes

  No

• Are all approaches and platforms effectively lit?

  Yes

  No

  N/A

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Tie registrar

• Tie registrar

  Yes

  No

  N/A

• 100% ties tensioned?

  Yes

  No

• Ties tensioned to manufacturer specifications?

  Yes

  No

• Ties correctly positioned and fixed?

  Yes

  No

• Ties fixed as per Australian Standards or engineers specifications?

  Yes

  No

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• Remedial action required

• Dubbo scaffold representative

  Sign

• Signed customer representive

  Sign

• Company

• Select date

  Date