Tub & cup lock scaffolding safety inspection checklist
Company name: Date & time:
Location of work activity: Height of scaffold:
Inspected By Name & signature:
Sr. N Check points Yes No Remark
1 Scaffold base is firm, level, and solid
2 Deck has no openings or uneven surfaces
3 Top rail, midrail and toeboard are in place
4 Scaffold height is 4 times the base width or less (free
standing)
5 Scaffold is secured every 8 meters (Vertical) and every 9
meters (Horizontal)
6 An access ladder or stairway is provided for workers
7 Scaffold tag is in plain view and has current inspection by the
competent person
8 Frames are pinned together at joints
9 Scaffold planks are secured and overlap the bearer edge by at
least 15cm
10 Scaffold planks connect over the bearers
11 Scaffold clamps and connectors are secure and tight
12 Scaffold boards overlap at least 30cm and are secured from
displacement
13 There are no damaged components (cut, burned, bent, or
badly rusted parts)
14 Rolling scaffolds have the wheels locked during use
15 Has a pre-task risk review (JSA & STA) been completed?
16 Are the posts, bearers, and diagonals in the proper place?
17 Pins or bolts secure each frame at the posts.
18 Base or mudsills do not exceed 45 cm.
19 Gaps in planks does not exceed 2.54 cm
20 Access ladder is clear of any poles or other obstructions
21 Scaffold has a current permit posted and has been checked
each shift that it is used.
Verified by P&G Safety Owner:
Verified by P&G Safety Owner once a week anytime