Document Title:-               Document No :- CIPL/ HSE/ 005/ 13
Rev:- 0
                                                      Scaffolding Safety Inspection Checklist   Date :-
Site :-                                                                Date :-
Location :-                                                            Forman/Supervisor :-
 Sl. No.                                        Activities                                Observation       Measures if not ok
              Ground Surfaces
    1         Ground level , no soft spot
    2         Footing timber level adequately supported
    3         No Unauthorized Entry
              Scaffolds
    1         Base plate level
    2         Spindle jack vertical
    3         Standard Plumb (vertical tubes) , no damage
    4         Ledgers level (horizontal tubes), no damage
    5         Diagonal bracing, check secure and non missing
    6         Lock pin in place and secure
    7         Support from permanent structure
              Ladders
    1         Check placed on level ground
    2         Position at an angle of 1:4
    3         Adequately secured
    4         No damage, check welds
    5         Extent 4 rungs above stepping off point
    6         Uniform and proper spacing of rung
              Working Platform
    1         Should not be less than 600 mm wide
    2         Guard rails adequate check
                    i)      Top rail at least 910 mm height
                    ii)     No gap greater than 470 mm
    3         Boards free of defects check
                    i)      No gaps
                    ii)     Adequate supports
                    iii)    No risk of trips
                    iv)     Properly secured / tied
              PPE
    1         Helmet and footwear worn
    2         Safety harnesses as required and secured above shoulder level
    3         Use of safety belt while working at height
    4         Safety Goggles during welding / gas cutting / Grinding etc.
  5       Condition / Maintenance of safety appliances
  6       Use of body guards, gloves etc.
                                                              Document Title:-              Document No :- CIPL / HSE/ 005/ 13
                                                                                            Rev:- 0
                                                  Scaffolding Safety Inspection Checklist   Date :-
                                                                                            Page 2 of 2
         Means of Access
 1       Platform , toe board and railings
 2       Scaffoldings – its condition and maintenance
 3       Staircase and railing
 4       Ladder & fixing
 5       Safe access to and from means of access
         Housekeeping
 1       Material stacking & storing
 2       Working / moving area clean
 3       Access / Main Approach / Passages free form obstacles
 4       Cordoning / covering of pit , vat, machine foundation etc.
 5       Displaying of Red Flags / Tape / light
 6       Removal of unwanted materials like excavated earth debris etc.
Prepared By :-                                                        Verified By :-
Name:-                                                                Name :
Signature :-                                                          Signature