Scaffold inspection
Work Site
*
224 Muskrat Street
208 Otter Street
Add Work Site if not shown
Company
*
Name of Inspector
*
First Name
Last Name
Inspector Email
*
example@example.com
Date of Inspection
*
-
Month
-
Day
Year
Date
Type of Scaffold
*
Frame scaffolding
Single or double pole scaffolding
Tube and clamp
Ladderjack scaffolding
Pump Jack scaffolding
Needle beam scaffolding
Other
General Requirements
*
Rows
Yes
No
Comments
Is the supporting surface where the scaffold is erected capable of withstanding its weight?
Is the scaffold erected on dirt? If YES are mud sills installed under each point of contact to support load?
Is there any potenitial for contact with exposed electrical equipment and conductors ( l.e overhead energized power and communication lines)?
Are the workers trained and supervised in how to confirm structural capability?
Has the scaffold been installed as specified by the manufacturer's instructions, applicable standards, and engineers requirement ( i.e..., have all the cross braces been installed)?
If applicable, are the manufacturers or engineers instruction readily on site?
Has the scaffold been inspected before each use ( i.e.., yellow tag and red tag system ) ? Tag current?
Is there any safe way to get on and off the scaffold, such as a ladder ?
Is the scaffold able to withstand the load likely to be imposed on it
Where applicable, have guardrails and toe boards been installed on all open slides where the open space is greater than 30 cm ( 12 in) ( i.e the open space between the platform and the adjacent structure) ?
Are the platforms at least a nominal width of 50 cm (20 in )?
Have the platform been secured against separation from the supporting equipment, structure or surface?
Is the platform fully planked or decked with no gaps greater than 25cm (10 in )?)
Are the ledgers and bearers level and the vertical member plumb?
Is the scaffold height more then three frames tall? If YES are the outriggers firmly attached to the scaffold and stable?
Is there a safe way of getting materials on each platform on scaffold ( i.e.., workers cannot carry materials or equipment up or down a ladder)?
Are the workers required to work below with scaffold? If so, is appropriate protection against falling materials in place?
Do all connections have securty pins in place?
Wood-frame scaffold requirement
Rows
Yes
No
Comments
Is the lumber used to construct the scaffold graded and marked to the National Lumber Grading Rules for Canadian Lumber ( i.e No 2 or better lumber that is Douglas fir-larch, hemlock-fir, spruce-pine-fir, or coast Sitka spruce)?
Is the lumberfreed of cracks, splits, knots, and damages?
Manufactured scaffold requirement
Rows
yes
no
Comments
Are all brace, bearers, clamps, and other connection appropriately secure?
Rolling scaffold requirement
Rows
Yes
No
Comments
Are wheels and casters locked while workers while are on scaffold?
Is the scaffold designed and intended to be move while a worker is on platform?
Take a picture of the signed and dated inspection tag
Upload or take a picture
Drag and drop files here
Choose a file
Cancel
of
Inspector's Signature
*
Submit
Should be Empty: