Title Page

  • Location / Site

  • Prepared by

  • Conducted on


  • Photos

  • Scafftag fitted at all access points and clearly visible

  • Access built to requirements

  • Scaffold within the inspection period

  • Competent person erecting / modifying / dismantling

  • Where erecting, modifying or dismantling area below barricaded & sign posted

  • Erect / dismantle – Harness & lanyards used correctly

  • Handrail, Midrail & toe board fitted

  • Ladder(s) are 1 mtr above the landing platform

  • Ladder(s) secured

  • All working platforms are fully planked & secured

  • Ladder safety rail fitted to access

  • SWMS reflect tasks, identifies hazards and appropriate controls are in place

  • Scaffold materials stored in a safe manner

  • Where scaffold in use – Materials stored correctly

  • Encapsulation fitted where objects may be dislodged / fall

  • Penetrations in platforms/access ways covered/toe boards fitted

  • Swing gates correctly fitted

  • Further Findings:


  • Name:

  • Select date

  • Signature:

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