EAGLE ELECTROMECHANICAL CO.
LLC
Project Name:                                                                   Date:
                           SCAFFOLDING SAFETY CHECKLIST
Area Inspected
                                DESCRIPTION                                      YES    NO      REMARKS
01   Is scaffolding erected by competent person?
     Have screw jacks been used to level and plumb scaffold instead of
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     unstable objects such as concrete blocks, loose bricks, etc.?
03   Are base plates and/or screw jacks in firm contact with sills and frame?
04   Casters are locked before work begins. (For mobile Scaffolding)
05   Is scaffold level and plumb?
06   Are all scaffold legs braced with braces properly attached?
07   Is guard railing in place on all open sides and ends?
08   Is toe board in place to avoid falling objects from height?
     Are scaffold components and planking in safe condition for use and is
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     plank graded for scaffold use?
10   Has proper access been provided?
11   Has cross bracing been provided?
     Has overhead protection or wire screening been provided where
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     necessary?
13   Has scaffold been tied to structure to avoid collapse?
     Have brackets and accessories been properly placed:
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              Brackets?
                Tube & Clamp?
                All nuts & bolts Tightened?
OTHERS:
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RECOMMENDATION:
INSPECTED BY:                                        DESIGNATION:                            SIGN:
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Doc.Ref.No: EECO/HSE/FORM/27                                                                 Rev#1 (12/2021)