Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Date requested:
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Address for scaffold
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Date Required:
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Load Class
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Brief description of Work & Likely Loading
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Select elevations to be covered
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Working lifts required
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Select any additional Items required:
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Select any of the following hazards present
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*Where any of these are present the scaffold is not to be erected until it has been confirmed that any necessary isolation / removal has been confirmed.
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*Note: where the scaffold is being erected for the purpose of asbestos removal, The scaffold Company may need to hold an Ancillary Asbestos Licence. (See CAR Reg 8 / ALU Memo 01/10) | For Gas Flues refer to Gas Reg 8 Procedure IMSP005
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Select other relevant considerations:
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Please take a photo and annotate it, showing the locations of access onto the scaffold of any items highlighted in the additional items section
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Signature
