Title Page

  • Project address

  • Client

  • Elevation (N,S,E,W)

  • Conducted on

  • Prepared by

  • Location
  • Are all parts of the scaffold at least 3m away from unprotected power lines

  • Is the scaffold erected a safe distance away from trenches or excavations

  • Is the ground/substrate suitable for scaffold construction

Scaff tags/access and egress

  • Are scaff tags visible at all access and egress points

  • Is scaffold equiped with ladder access to all working platforms

Scaffold structure

  • Are all screwjacks/feet set upon baseplates

  • Are all standards/screwjacks bearing firmly (not floating)

  • does the scaffold feel stable

  • Are guardrails installed everywhere necessary

  • Are there sufficient wall ties

  • Are diagonal braces installed everywhere necessary

Working platforms

  • Are working platforms installed at all necessary working areas

  • Are the working platforms suitable for their intended purpose.

  • Are the working platforms constructed for their intended loads.

  • Are all working platforms fully decked and free from unsafe gaps.

  • Are toe boards installed adequately

  • Is debris net installed in place of toe boards

Loading tower

  • Has a loading tower been created

  • Is the loading tower built with truss ledgers for increased load capacity

  • Are brick guards and toe boards installed at every working platform

Netting and tarping

  • Is a roof structure installed

  • Is scaffold tarped on sides

  • Is scaffold properly secured, using ties and push-tubes

  • Is debris net installed on sides of scaffold

General notes

  • Are there any areas of concern that should be noted.

signature

  • Please sign

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