CHECKLIST SCAFFOLDING INSPECTION

Proyek :
Tanggal Inspeksi :
Type Scaffolding :
No. register :
Klasifikasi Scaffolding : 1 Light Duty (225 kg) 2. Medium Duty (450 kg) 3. Heavy Duty (675kg)

Scaffolder Name : 1 4
2 5
3 6

Condition
No Item Inspection Specification
Good Bad
1 Ground / Kondisi Tapak Soil
Pouring
2 Sole plate Kayu
Plat
3 Base plate adjustable base plate
Fix base plate
4 Transome Diameter pipa
Ketebalan pipa
5 Ledger Diameter pipa
Ketebalan pipa
6 Frame Diameter pipa
7 Cross bracing/Silang Diameter pipa
8 Pengunci cross bracing Plate
Lainnya
9 Cat walks Cat walks
Kayu
10 Tangga Ladder frame
Tangga alumunium
11 Handrail Diameter pipa
12 Pipa support/out rigger Diameter pipa
13 Top rail Diameter pipa
14 Mid rail Diameter pipa
15 Toe board Papan kayu
Metal plank/ashiba

STATUS SCAFFOLDING OK TIDAK BAIK

Di inspeksi oleh Tanggal Tanda tangan
N

Duty (675kg)

Remarks
Tanda tangan