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SCAFFOLD INSPECTION Rev. No. 0

Eff. Date
CHECKLIST Page No. 1 of 2
Bin Quraya Est.

Project Name:
Project Location:
Purpose of Scaffold:
Name of Erector: SI Control No.
Name of User: Scaf Tag. Issued No.

Scaffold Types
Independent Mobile/Hanger Drop/Hanging (Suspended)

Item Description Status

1 Stable / Level Ground Yes No N/A

2 Base Plates Yes No N/A

3 Adjustable Base Plates Yes No N/A

Standards (check only one), Light Duty, Medium Duty, Heavy Duty,
4
All Duty
3.0 meters (10 ft.) Max. Longitudinal Spacing (Light Duty) Yes No N/A

2.4 meters (8 ft.) Max. Longitudinal Spacing (Medium Duty) Yes No N/A

1.98 meters (6.5 ft.) Max. Longitudinal Spacing (Heavy Duty) Yes No N/A

1.8 meters (6 ft.) Max. Longitudinal Spacing (for all types) Yes No N/A

5 Ledger

At 2.0 meters (6.5 ft.) Vertical Headroom Yes No N/A

Secured to Standard w/ Load Bearing Coupler Yes No N/A

6 Transom

Secured to Standard w/ Load Bearing Coupler Yes No N/A

Bearing Upon Ledger (never fix under Ledger) Yes No N/A

Within 1-foot of Standard (offset) Yes No N/A

7 Board bearer / Intermediate Transom Yes No N/A

8 Ledger (Cross) Brace (Transversal) every 3rd Post / 4th Runner Yes No N/A

9 Sway Brace (Longitudinal @ 45 degrees) Yes No N/A

10 Toe Boards (4 high-minimum-all sides) Yes No N/A

11 Guard Rails (all sides) Yes No N/A

Top Rail (36 42 high) Yes No N/A

Mid Rail Yes No N/A

12 Decking Yes No N/A

Secured / No Openings Yes No N/A

 Doc. Code

SCAFFOLD INSPECTION Rev. No. 0

Eff. Date
CHECKLIST Page No. 2 of 2
Bin Quraya Est.

2 Plank Minimum Width Yes No N/A

End Plank Overhang within 6 12 (10 Plank); 6 18 (>10 Plank) Yes No N/A

Level (Max. Slope: (1 Vertical to 4 Horizontal) Yes No N/A

13 Ties (At each End; Every 26 Vertically; 30 Horizontally) Yes No N/A

14 Personnel Access / Ladders Yes No N/A

Adequate Access Ladders Yes No N/A

Extended (36 Minimum) Beyond Stepping-Off Point Yes No N/A

Securely Fixed by Side Rails (Stiles) NOT by Rungs Yes No N/A

Safety Gate Provided at Access Point(s) Yes No N/A

Obstruction Free Yes No N/A

Rungs Not Loose / Stiles Damage Free Yes No N/A

75 degrees Angle (Inclined Ladder) Yes No N/A

Side-Step Position (To & From Landing) Yes No N/A

15 Mobile Scaffolds Yes No N/A

Maximum Height = 4 x Minimum Base Width Yes No N/A

Caster w/ brake, Wheels fixed to base w/ Locking Pins Yes No N/A

Outriggers Required / Provided (beyond 4:1 height-base ratio) Yes No N/A

Remarks

Authorized Scaffold Inspector:

Name: Signature: Date:

Prepared by: Approved by: Noted by:

HSE Manager Project Manager