Daily Scaffold Inspection Checklist
Project Name
*
Please Select
UCSD Central Utility Plant
UCSD Geisel Library
Project Number
*
Please Select
5200351 - UCSD Central Utility Plant
5200357 - UCSD Geisel Library
Company Name
*
Date
*
/
Month
/
Day
Year
Date
Competent Person Name
*
Scaffold Location
*
Ladder or other suitable means of access is in place
*
Yes
No
N/A
Scaffold near construction traffic ways are protected
*
Yes
No
N/A
All footings level, rigid, and capable of supporting the load
*
Yes
No
N/A
Sill are proper size, in place and centered under base plates
*
Yes
No
N/A
Screw-jacks have firm contact with frame and base plates pinned to frame
*
Yes
No
N/A
Scaffold is plumb and level
*
Yes
No
N/A
Height to base ration exceeds 3 to 1 and scaffold is restrained from tipping
*
Yes
No
N/A
Legs are braces and braces are properly attached
*
Yes
No
N/A
Platforms extend within 16" of the finished face of the building
*
Yes
No
N/A
All working levels are fully planked, at least 18" wide, and not used if slippery
*
Yes
No
N/A
Planks overlap at least 12" and overlap is over a bearer
*
Yes
No
N/A
Plank overhand is 6"-12" on 10' plank and 6"-18" on planks longer than 10'
*
Yes
No
N/A
Cleats are installed on the end of planks when planks don't overhang at least 6"
*
Yes
No
N/A
Planks don't deflect more than 2" in the middle and are in good condition
*
Yes
No
N/A
Gaps between planks are not greater than 1"
*
Yes
No
N/A
Guardrails are in place on sides and ends of platforms or workers protect by a personal fall arrest system
*
Yes
No
N/A
Workers below are protected with screens or barricades
*
Yes
No
N/A
Toe boards are in place when required access/egress is below or potential for material to fall on other workers
*
Yes
No
N/A
Scaffolds, materials, and workers are at least 10' away from power lines
*
Yes
No
N/A
Other companies using scaffold have signed the equipment loan and indemification form
*
Yes
No
N/A
Rolling Scaffolds
Below is a checklist for rolling scaffolds
Other companies using scaffold have signed the equipment loan and indemification form
*
Yes
No
N/A
Diagonal braces in place to keep from racking when being moved
*
Yes
No
N/A
Floor holes covered, secured and marked
*
Yes
No
N/A
All wheels are locked and operate
*
Yes
No
N/A
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