Swing Stage Inspection

• Conducted on:

  Date

• Building Name:

• Building Address:
  Address

• Completed By:

  Select

Swing Stage Information

• Swing Stage Size:

• Number of Beams / Hoists:

• Counterweights per Beam (# of 50lb plates):

Roof

• Beams Free of Bends or Twists

  Safe

  At Risk

  N/A

• Beam Lock Pins In Place

  Safe

  At Risk

  N/A

• Suspension Lines Properly Attached to Beams

  Safe

  At Risk

  N/A

• Beams and Counterweights Tied Back

  Safe

  At Risk

  N/A

• Correct Counterweight Used

  Safe

  At Risk

  N/A

• Engineered Anchors

  Safe

  At Risk

  N/A

• Beam Support System Secure

  Safe

  At Risk

  N/A

• Safety Lines

  Safe

  At Risk

  N/A

Work Platform

• Platform Connections

  Safe

  At Risk

  N/A

• Guardrails & Midrails

  Safe

  At Risk

  N/A

• Decks

  Safe

  At Risk

  N/A

• Lock Pins In Place

  Safe

  At Risk

  N/A

• Within Safe Working Limit

  Safe

  At Risk

  N/A

Motor & Hoisting Equiment

• Beam Spacing and Alignment

  Safe

  At Risk

  N/A

• Cables Fed Through Correctly

  Safe

  At Risk

  N/A

• Electrical Cord Free of Twists & Knots

  Safe

  At Risk

  N/A

• Electrical Cord Knot Self Tightening & Secure

  Safe

  At Risk

  N/A

• Ascending & Descending Controls

  Safe

  At Risk

  N/A

• Secondary Safety Controls

  Safe

  At Risk

  N/A

• Additional comments or observations

  Yes

  No

  N/A

• Additional Notes:

Notes

• Note:

• I hereby certify that all information is accurate and that an actual inspection was conducted as per company policy.

• Inspector's Printed Name & Signature

  Sign

• Worker's Printed Name & Signature

Worker:

• Add signature

  Sign