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SCAFFOLD INSPECTION REPORT

Name and address Location of place of work


of person on whose Inspected (ie site address)
behalf the
inspection was
carried out
(1) (2)

Description of place of Date and Details of any matter identified that could give rise to a Details of any action taken as a Details of any further action Name and
work or part time of risk to the health and safety of any person result of (5) considered necessary position of
inspected (including inspection the person
any plant, equipment making the
and materials) report
(3) (4) (5) (6) (7) (8)

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