Scaffold Inspection Report

• Scaffold Inspection Report

• (Year-day-month)

• Client / Site

• Conducted on

  Date

• Prepared by Mike Casady

• Location
  Address

• Personnel

Scaffold

• Sub base in good condition?

  Yes

  No

  N/A

• Mudsills in place?

  Yes

  No

  N/A

• Adjustable jacks/base plates?

  Yes

  No

  N/A

• Caster wheels (with brakes)

  Yes

  No

  N/A

• Engineers certificates on record?

  Yes

  No

  N/A

• Unused components correctly stored

  Yes

  No

  N/A

• Mesh to access stairs

  Yes

  No

  N/A

• Planks (full decks)

  Yes

  No

  N/A

• Required permits on record

  Yes

  No

  N/A

• Toe boards installed

  Yes

  No

  N/A

• Handrails installed

  Yes

  No

  N/A

• Mesh guards installed

  Yes

  No

  N/A

• Access provided (ladders etc)

  Yes

  No

  N/A

• Ladder secured

  Yes

  No

  N/A

• Access stairs with handrails

  Yes

  No

  N/A

• Scaffold tag displayed

  Yes

  No

  N/A

• Scaffold clean/clear for access

  Yes

  No

  N/A

Scaffolder inspection

• Correct number of work platforms

  Yes

  No

  N/A

• Ties and lock pins in place?

  Yes

  No

  N/A

• Diagonal, transverse and plan bracing

  Yes

  No

  N/A

• Planks lapped to regs

  Yes

  No

  N/A

• Correct distance from electrical (to regs)

  Yes

  No

  N/A

• Diagonal bracing

  Yes

  No

  N/A

• Correct distance from workface

  Yes

  No

  N/A

• Scaffold not overloaded

  Yes

  No

  N/A

• Competent person on site?

  Yes

  No

  N/A

• Engineers report required?

  Yes

  No

  N/A

• Calculations and Design criteria recorded?

  Yes

  No

  N/A

Final Comments:

• Final Comments:

  Yes

  No

  N/A

• Safety Director:

  Sign

• Superintendent:

  Sign