Supported Scaffold/Sidewalk Shed Inspection

• Site conducted

• Conducted on

  Date

• Prepared by

• Location
  Address

General Information

• Permit #:

• Name of Scaffold Erector:

• Installation Date:

  Date

• Expiration Date:

  Date

• Renter's Name

• Phone #:

• Drawing on Site for Inspection?

  Yes

  No

  N/A

Specific Information

• Scaffold Height:

• Number of Platforms Decked

• Are there signs on the parapets?

  Yes

  No

  N/A

Maintenance Information

• Are the base plates & mud sills secured?

  Yes

  No

  N/A

• Are all the scaffold pins & bolts installed?

  Yes

  No

  N/A

• Are the legs and poles plumb, braced and not displaced?

  Yes

  No

  N/A

• Are cross braces fully attached, not bent, and not missing?

  Yes

  No

  N/A

• Are tie-ins correctly spaced, properly secured & the correct amount?

  Yes

  No

  N/A

• Are pipe clamps tight?

  Yes

  No

  N/A

• Are window jacks tight?

  Yes

  No

  N/A

• Are all the planks secured?

  Yes

  No

  N/A

• Are decking and planks in good condition?

  Yes

  No

  N/A

• Is deck fully planked?

  Yes

  No

  N/A

• Are there any gaps or open spaces (> 1") on decking?

  Yes

  No

  N/A

• Are the guardrails & toe boards secured at all places where required?

  Yes

  No

  N/A

• Is the netting extension of full length and height?

  Yes

  No

  N/A

• Is the netting secured?

  Yes

  No

  N/A

• Is the parapet the proper height and secured?

  Yes

  No

  N/A

• Are the lights working?

  Yes

  No

  N/A

• Is the deck clean and free of debris?

  Yes

  No

  N/A

Approval

• Signature:

  Sign

• Date:

  Date