Peri Australia Pty.

Limited
116 Glendenning Road
Glendenning NSW 2761
Australia
ACN 078 003 568
Ph (02) 88052300
Fax (02) 9675 7277

PERI SCAFFOLD INSPECTION CERTIFICATE

PROJECT:
COMPANY:
AREA:
DATE:
ENGINEER:
EXCLUSION NOTES
1)
2)

This inspection is for PERI material ONLY.

No responsibility is taken for ground conditions or any other support below
the underside of the base plate.
3)
No responsibility is taken for site modifications not authorized by PERI.
4)
No responsibility is taken for bad workmanship. (Items that are not
obviously visible)
5)
Inspection applies only to completed work at time of inspection.
6)
Inspection is provided to the top of the last fully completed scaffold deck.
7)
This inspection does not relieve any other party of their responsibilities. Ie
situations over which PERI has no control.
RECTIFICATIONS REQUIRED/NOTES:

ANOTHER PAGE OF RECTIFICATIONS ATTACHED

YES

NO

CERTIFICATION
Taking to account the above exclusion notes, the scaffold inspected is structually
adequate to take the loads as specified in AS1576.
PERI FORMWORK & SCAFFOLDING
ENGINEER:
DATE:
SIGNITURE:
(IF THIS CERTIFICATE IS NOT SIGNED- THEN IT IS NOT VALID)