Title Page

  • Client / Site

  • Conducted on (Date and Time)

  • Prepared by

  • Location

GENERAL CHECKLIST

  • Are all the sufficient scaffold components in place and without any defects?

  • Are the base plates in firm contact with mud sills and the frame of the scaffold?

  • Are all scaffold legs braced and braces properly attached to the scaffold?

  • Is the scaffold secured to the structure to prevent movement?

  • Are brackets, tubes, planks & accessories properly placed with wedges tightened?

  • Is a toe board properly installed when necessary?

  • Are all scaffold components and planking in an acceptable condition?

  • Are all planks correctly graded?

  • Is a qualified, competent person in charge of the erection/inspection?

  • Is the whole scaffold level and plumb?

  • Are mud sills properly placed and adequately sized where ever required?

  • Were screw jacks used to level and plumb the scaffold whenever required?

  • Are all necessary guard rails in place on all open sides and ends?

  • Has a gate been installed and does it open outwards.

  • Has there been a visual check to verify clamps are secured in place?

  • Is there proper access to get on and off the scaffold?

  • Has "Don't Use" tag been placed at all access points where inspection failed?

  • Has the scaffold control tag been signed and approved for this particular use?

  • Do all planks have a minimum of 12" overlap and extend 6" beyond supports?

  • Is the ladder secured and in place?

COMPLETION

  • Recommendations

  • Signature of Scaffolder

  • Full Name and Signature of the Inspector

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.