Scaffolding Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• 1.1. Are sills properly placed and adequately sized?

  Safe

  At Risk

  N/A

• 1.2. Have screw jacks been used to level and plumb scaffold instead of unsafe objects such as concrete blocks?

  Safe

  At Risk

  N/A

• 1.3. Are base plates and or screw jacks in firm contact with sills and frames?

  Safe

  At Risk

  N/A

• 1.4. Are all scaffold legs braced with braces properly attached?

  Safe

  At Risk

  N/A

• 1.5. Is guard railing in place on all open sides and ends about 10' level?

  Safe

  At Risk

  N/A

• 1.6. Have ladders been provided as a means of access to the scaffold?

  Yes

  No

  N/A

• 1.7. Have freestanding towers been guided or tied so as not to exceed the 4 to 1 base height ratio IAW Subpart "L" of the OSHA standards 29 CFR 1926.451(c)(1)(ii)

  Safe

  At Risk

  N/A

• 1.8. Are working level platforms fully planked between guard rails with no split planking used?

  Safe

  At Risk

  N/A

• 1.9. Does planking have a minimum 12'' overlap extended beyond supports and cleated at ends?

  Safe

  At Risk

  N/A

• 1.10. Are toe-boards installed properly?

  Safe

  At Risk

  N/A

• 1.11. Has a tie off analysis been performed?

  confirmed

  unconfirmed

  N/A

• 1.12. Are safety harnesses available for use when needed?

  Yes

  No

  N/A

• 1.13. Is there a competent scaffold person onsite?

  Yes

  No

  N/A

• 1.14. Have all employees working on scaffold been informed of and trained in safe working practices while working on the scaffold?

  Yes

  No

  N/A

• 1.15. Are out riggers properly installed at 90° angles perpendicular to the building?

  Yes

  No

  N/A

• 1.16. Has scaffolding been altered by workers or subs?

  Safe

  At Risk

  N/A

• 1.17. Have scaffold components been properly inspected for damage and capability?

  Yes

  No

  N/A

• 1.18. Are platforms fully planked with gaps no greater than 1 inch?

  Safe

  At Risk

  N/A

• 1.19. Are scaffold hatches being closed after use?

  Safe

  At Risk

  N/A

• 1.20. Is scaffolding set up proper distance from power lines, or have lines been de-energized?

  Safe

  At Risk

  N/A

Rolling scaffolds

• 2.1. Are wheel brakes operable, and have employees been instructed to set breaks while in use?

  Yes

  No

  N/A

• 2.2 Are safety rails installed at the 10-foot level, or some other type of fall protection?

  Yes

  No

  N/A

• 2.3. Have caster or wheel stems been pinned or otherwise secured to prevent them from coming separated from the scaffold legs?

  Yes

  No

  N/A

• 2.4. Are outriggers (if required) properly installed on both sides of rolling towers?

  Yes

  No

  N/A

• 2.5. Have employees been properly instructed in the safety procedures for using rolling towers Baker or Perry scaffolds?

  Yes

  No

  N/A

• Add signature

  Sign

• Add signature

  Sign