Doc.
Code
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
