Title Page
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Jobsite Location:
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Job #
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Date of Inspection:
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Weather - Select all that apply
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Superintendent (s):
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Competent Person:
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Prepared by
Items for Inspection
Scaffold Incpection
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Are Sills properly placed and adequately sized?
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Have screw jacks been used to level and plumb scaffold instead of unsafe<br>objects such as concrete blocks?
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Are base plates and/or screw jacks in firm contact with sills and frames?
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Are all scaffold legs braced with braces properly attached?
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Is guard railing in place on all open sides and ends above the 6-foot level?
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Have ladders been provided as a means of access to the scaffold?
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Have free standing towers been guyed or tied so as not to exceed the 4 to 1<br>base height ratio
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Are working level platforms fully planked between guard rails with no split<br>planking used?
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Does planking have minimum 12” overlap extended beyond supports and<br>cleated at ends?
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Are toe-boards installed properly?
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Are safety harnesses available for use when needed?
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Have all employees working on scaffold been informed of and trained in safe<br>working practices while working on the scaffold?
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Are out riggers properly installed at 90 degree angles perpendicular to the<br>building?
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Have scaffold components been properly inspected for damage and<br>compatibility?
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The load limit for this scaffold is _______ lbs per square foot. Has this<br>information been communicated to workers utilizing the scaffold?
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Inspection results
