Title Page

  • Conducted on

  • Prepared by

  • Location
  • Is there an accessible area below the work?

  • Comments?

  • Barricades are in place on 4 sides with updated tags in place?

  • Comments

  • Signs are in place explaining the reason for the barricade?

  • Comments?

  • The perimeter within barricaded area is sufficient for safe operations. Within potential drop zones?

  • Comments?

  • Communication with other contractors working in proximity established?

  • Comments?

  • All debris and unnecessary materials on and around the scaffold or in lifts are removed regularly?

  • Comments?

  • Proper guard rails and toe boards installed?

  • Comments?

  • There are no gaps between toe boards and work surface.

  • Comments?

  • There are no gabs between adjoining toe boards.

  • Comments?

  • Toe boards are at least 3.5” high?

  • Comments?

  • Guardrails have a mid and top rail?

  • Comments?

  • Debris netting installed with no gaps exceeding 1” - Not ripped

  • Comments?

  • Unnecessary tools and materials removed from decks?

  • Comments?

  • Openings in scaffold decks covered, secured and marked with high vis?

  • Comments?

  • Safe entrance to scaffolding/netting does not create another hazard when entering the work area?

  • Comments?

  • Hand tools and other equipment secured with lanyards and acceptable tie off points?

  • Comments?

  • Ropes in good condition and adequate for hoisting?

  • Comments?

  • Ropes attached to tool bags (must be canvas with zip top) with locking carabiners?

  • Comments?

  • All materials properly secured away from scaffold deck edges?

  • Comments?

  • No material or tools propped up against structure or guard rails?

  • Comments?

  • Pre start inspection: Debris removed? Tools removed?

  • Comments?

  • End of shift inspection: Debris removed? Tools removed?

  • Comments?

  • Inspected by:

  • Signatures:

  • Verified by:

  • Signatures:

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