DOCUMENT CODE

ICPL-HSE-PRO-003

REV. # 00

REV. DATE: 00-00-0000

(TO BE ATTACHED TO WORK PERMIT)

ICPL-HSE-F-000

SCAFFOLDING CHECK LIST

Date:__________

Time:___________

Area:_________

Description _______________________________________

CHECKS

NA

1 Cross Bracing across width of

scaffold installed
2 Diagonal Bracing installed
3 Planks in good condition
4 Planks extend between 6" -12"
Beyond the end Supports
5 Guard Rail at 3' - 3.5' installed
6 Mid-rail Halfway between
platforms & top rail
7 Toe board installed

Ladder installed which extends

at least 3 ft.. beyond

No hot line or Bare electric wire

in the vicinity

1 Scaffolding
0 Secure

seems

safe

&

Remarks: ___________________________________
_____________________________________________
_________________
Area Engr/ End User

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