Title Page
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Conducted on
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Prepared by
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Location
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Is there an accessible area below the work?
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Comments?
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Barricades are in place on 4 sides with updated tags in place?
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Comments
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Signs are in place explaining the reason for the barricade?
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Comments?
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The perimeter within barricaded area is sufficient for safe operations. Within potential drop zones?
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Comments?
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Communication with other contractors working in proximity established?
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Comments?
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All debris and unnecessary materials on and around the scaffold or in lifts are removed regularly?
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Comments?
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Proper guard rails and toe boards installed?
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Comments?
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There are no gaps between toe boards and work surface.
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Comments?
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There are no gabs between adjoining toe boards.
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Comments?
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Toe boards are at least 3.5” high?
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Comments?
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Guardrails have a mid and top rail?
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Comments?
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Debris netting installed with no gaps exceeding 1” - Not ripped
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Comments?
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Unnecessary tools and materials removed from decks?
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Comments?
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Openings in scaffold decks covered, secured and marked with high vis?
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Comments?
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Safe entrance to scaffolding/netting does not create another hazard when entering the work area?
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Comments?
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Hand tools and other equipment secured with lanyards and acceptable tie off points?
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Comments?
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Ropes in good condition and adequate for hoisting?
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Comments?
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Ropes attached to tool bags (must be canvas with zip top) with locking carabiners?
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Comments?
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All materials properly secured away from scaffold deck edges?
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Comments?
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No material or tools propped up against structure or guard rails?
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Comments?
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Pre start inspection: Debris removed? Tools removed?
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Comments?
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End of shift inspection: Debris removed? Tools removed?
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Comments?
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Inspected by:
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Signatures:
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Verified by:
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Signatures: