Information
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Client
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Project name
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Project number
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Project supervisor
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Location of project
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Inspection Conducted on
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Prepared by
General project description
General Scaffold Requirements
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Has the scaffold been constructed and loaded in accordance with the design of a qualified person and with a safety factor of at least 4 to 1?
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Has the maximum load capacity of this scaffold been communicated to the customer?
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Have all scaffold components been inspected prior to installation?
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Is the scaffold plumb, square and level?
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Is the scaffold built on a suitable foundation?
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Are base plates and mud sills adequate?
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Is all bracing installed in accordance with the manufacturers instructions and/or OSHA regulations
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Is proper clearance maintained around power lines?
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Is the scaffold built four times higher than its width?
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Is the scaffold braced or secured to prevent collapse?
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Are ties or guys installed installed at the 4 : 1 height and repeated every twenty feet vertically
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Are guys or ties installed at both ends and at least every thirty feet horizontally?
Platform Construction
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Are all working platforms fully planked? (with less than 1" spaces between planks or between planks and uprights)
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Where a larger gap is necessary, is the gap between the last plank and the uprights less than 9 1/2 inches?
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Are all working platforms at least 18 inches wide?
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Are the planks overlapped on supports?
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Are abutted planks resting on separate support surfaces?
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Do planks extend at least six inches but no more than twelve inches over the end supports? Or, do planks have cleats, hooks, or are they otherwise restrained?
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Are planks scaffold grade or equivalent?
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Are the planks in good condition and free of splits, cracks, cuts, or other damage?
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Are tops and bottom surfaces of scaffold planks visible and free from paint or other opaque covering?
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Fall Protection
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Does the scaffold have all required guard rails and toe boards?
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Are the open sides of the scaffold platform less than 14 inches from the face of work?
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Is fall protection provided when the platform is more than 14 inches from the face of work?
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Where necessary, have screens been installed to prevent objects from falling from the platform?
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Has the public been adequately protected from falling objects?
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Pictures
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Customer Acceptance. By signing below, the customer accepts the scaffold as built and agrees to all terms and conditions of the contract
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