Scaffold Details

Drawing No/TG20: Compliance Sheet Ref.

Description of section handed over/ Type of Scaffold

No. of Ties:

Tie Assembly/Configuration
Type of Tie

Design/ Tie Load

Proof test tie load X 1.25 safety factor

PROOF TEST

Location of tie tested

Test Load Applied (kN)

Test Result

Scaffold Loading

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

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
Name

Client/contractor

Name:
Date & Time of Handover

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

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.