Swing Stage Inspection

• Document No.

• No. of Stages.

• Job Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Are end gate/ deck pins in place and secured?

  Yes

  No

  N/A

• Is guard rail in place and operational on both sides?

  Yes

  No

  N/A

• Are undercarriage bolts in place and secure?

  Yes

  No

  N/A

• Are motor mount pins in place and secure?

  Yes

  No

  N/A

• Wind Conditions. Above 20 mph all operations should be grounded.

• Are load capacities being observed?

  Yes

  No

  N/A

• Is fall protection available for all workers on platform and rope grab hardware in working condition?

  Yes

  No

  N/A

• All workers on the platform tied off?

  Yes

  No

  N/A

• Adequate warning system on the ground level for overhead hazards?

  Yes

  No

  N/A

Rooftop anchors and scaffold framing/ towers.

• All electric cords and plugs in proper working condition?

  Yes

  No

  N/A

• All scaffold frames assembled properly and complete?

  Yes

  No

  N/A

• Scaffold wheels locked or properly cribbed?

  Yes

  No

  N/A

• All shackles secure and in operable condition?

  Yes

  No

  N/A

• All safety tie-backs anchored to rated system and cable hanging near a 30 degree angle?

  Yes

  No

  N/A

• Fall protection anchored into a rated system and ropes in operable condition?

  Yes

  No

  N/A

• There’s at least 1250 lbs of counter weight on each scaffold frame/tower?

  Yes

  No

  N/A