SCAFFOLD PERMIT Contractor Area Date Speifie Location Scaffold mnmber. Supervisor Builder ‘Print mame) Pinta) Purpose of Scaffold Length of Time Needed ‘Type of Seal, ‘Maxim Number of personnel Permited. Height Length at Base Wide at base {Load Linit Masini = Total Ke ‘Medium duty: Maximum Load Limit Kg = Width at Base X2.8 meters length X25 Kaisa. meter Heavy duty: Maximum Load Limit Kg = Width at base X 1.8 meters ength X 34 Ksq. meter Maximum Personnel = Maximum Load Limit (divided by) 360 NOTE: Ifa special attached. scaffold or an engineer designed scaffold, the design drawing and specifications must be 'PRE-ERECTION APPROVALS, ‘The signatories below agree tothe information above User Date Scaffolding Superintendent Date safer, Dae CConstrction Manager Date ‘SCAFFOLD COMPLETION By signing here the scaffold builder verifis that the scaffold js complete. The seaffolding supervisor verifies that eas conducted an inspection and confirms that the scaffold is complete and that sit being build according to the information on this document and thatthe scaffolds ready for inspection. The user signs verifying thatthe seaffold is built according to his needs, ‘Scaffold Builder Date Completed. ‘Scaffolding Supervisor Date Scaffold User. Date AFTER ERECTION INSPECTION AND APPROVAL, ‘By signing below the Scaffolding Superintendent and the Competent Scaffold Inspector certifies thatthe safol is complete, meets all the saffoling and safety eterna that ts safe forse The scald nepestion form mst be sed forthe inspection ofthe ‘calfold. A conpleted green SCAFTAG nuust be stashed to the scaffold atte acess point with the scaffold waber writen onthe 'SCAFTAG (in case ofa specially scaffold or engineered design scaffold ora scaffold 12 meter and above in height. the Scaffolding Engineer aust sign 35 the Competent Scaffold spect) Competent Scaffold Inspector Date ‘Scaffold Superintendent Date