Toilet Inspection

• Client Name

• Site Name

• Location
  Address

• Prepared by

• Date:

  Date

• Drawing No/TG20: Compliance Sheet Ref.

• Description of section handed over/ Type of Scaffold

• No. of Ties:

• Tie Assembly/Configuration

  Select Drilled Anchors Physical Ties ( Box, Through, Lip Etc) Full Buttress Rakers (Max 6m Height and max tie load of 2.7kN)

  • Drilled Anchors
  • Physical Ties ( Box, Through, Lip Etc)
  • Full Buttress
  • Rakers (Max 6m Height and max tie load of 2.7kN)

• Type of Tie

  Select Drop In expansion Anchors ( For structural Concrete, Hard natural stone) Self Tapping Screws (for structural concrete, concrete blockwork, brickwork & Stonework, steelwork, timber) Nylon Anchors with Screw-in Eye Bolts (for structural concrete, concrete blockwork, brickwork & stonework) Resin Anchors (for structural concrete, concrete blockwork, brickwork & stonework) Self-tapping screw with Resin (for brickwork & stonework) Screw-in Eyes (for timber) Bolts (for steelwork)

  • Drop In expansion Anchors ( For structural Concrete, Hard natural stone)
  • Self Tapping Screws (for structural concrete, concrete blockwork, brickwork & Stonework, steelwork, timber)
  • Nylon Anchors with Screw-in Eye Bolts (for structural concrete, concrete blockwork, brickwork & stonework)
  • Resin Anchors (for structural concrete, concrete blockwork, brickwork & stonework)
  • Self-tapping screw with Resin (for brickwork & stonework)
  • Screw-in Eyes (for timber)
  • Bolts (for steelwork)

• Design/ Tie Load

• Proof test tie load X 1.25 safety factor

PROOF TEST

• Location of tie tested

• Test Load Applied (kN)

• Test Result

  Pass

  Fail

  N/A

• Scaffold Loading

  Select Load Class 1 - One platform @ 0.75kn/m2 and One 50% loaded platform at 0.375kN/m2 Load Class 2 - One platform @ 1.5kN/M2 and One 50% loaded platform @ 0.75kN/M2 Load Class 3 - One platform @ 2.0kN/M2 and One 50% loaded platform @ 1.0kN/M2 Load Class 4 - One platform @ 3.0kN/M2 and One 50% loaded platform @ 1.5kN/M2 Special designed loading (State load in notes as detailed on Design Drawing

  • Load Class 1 - One platform @ 0.75kn/m2 and One 50% loaded platform at 0.375kN/m2
  • Load Class 2 - One platform @ 1.5kN/M2 and One 50% loaded platform @ 0.75kN/M2
  • Load Class 3 - One platform @ 2.0kN/M2 and One 50% loaded platform @ 1.0kN/M2
  • Load Class 4 - One platform @ 3.0kN/M2 and One 50% loaded platform @ 1.5kN/M2
  • Special designed loading (State load in notes as detailed on Design Drawing

• The detailed requirements of the Work at Height Regulations 2005 with regards to guardrails, working platforms, toeboards, bracing & ties have been complied with

  Yes

  No

  N/A

• Description of any non-compliance with the Work at Height Regulations 2005 & recommended actions

• Details of any further action considered necessary

Important Customer Information

• In order to comply with Regulation 12 of the Work at height Regulations 2005, this scaffold must be inspected before first use, every 7 days (or following any events likely to have affected its strength or stability) and after any substantial addition, dismantling or other alteration. In order to comply with Regulation 12 (7), results of each inspection must be recorded in a report of inspection. It is also the responsibility of every employer under Schedule 3 to ensure that the requirements of the regulations which apply to their own employees are complied with.

• The scaffolding as described above has now been completed in accordance with client requirements. It is structurally sound and should only be used and loaded in accordance with the loads stated on this hand over certificate

• User’s Responsibilities, Scaffolding is safe if you comply with regulations and ALWAYS, - Ensure the scaffold specification meets your requirements - Check the use and loading is what you have specified and requested - Inspect scaffold before signing and accepting the handing over certificate - It is the Clients responsibility to carry out and keep a record of statutory 7-day inspections in accordance with the Work at Height Regulations 2005 - Keep the report or a copy of the report at your site during construction work and thereafter at your offices for 3 months - Use suitable warning signs for incomplete or unsafe scaffolds - Spread the load across the platform and avoid point loading – Instruct users on maximum loading specified - Use suitable loading towers and do not load materials directly to a standard working platform with a forklift etc - Report any damage to the scaffolding or scaffold materials to the scaffold contractor. -------------------------- Scaffolding is very dangerous if abused, NEVER - Remove ties - Remove, adjust, modify or alter any part of the scaffold - Overload the scaffold - Allow digging under or near the scaffold - Add sheeting or netting unless the scaffold has been designed for it - Never Forklift loads directly onto access scaffolds, always use a loading platform

• Scaffold contractor

  Select Lenehan Scaffolding (Preston) Limited

  • Lenehan Scaffolding (Preston) Limited

• Name

  Sign

• Client/contractor

• Name:

  Sign

• Date & Time of Handover

  Date

• If no signature, Certificate despatched to client by (If sent by electronic means, a sending receipt must be stored)

  Post hard copy

  Email PDF Copy

  Fax Hard Copy