SCAFFOLDING SAFETY REPORT

Report No: Date:

Client: Contract No:
Site/Premises:
Project Manager: Inspected by:
This report follows a Safety Inspection of the above contract on the date stated. Should any items be
indicated with an ‘X’ then the Inspector will issue the Agent/Manager with an Improvement Request
detailing the items requiring attention in order of priority. Items marked with an asterisk ‘*’ are considered
to be an imminent risk of serious injury or damage and should be attended to immediately.
1. Scaffolding Housekeeping Scaffold Platform
Sole/Base Plates Materials stacked safely Free from trip hazards
Standard/Ledgers All area safe and tidy Boards in good condition
Sleeves staggered Platforms free from materials External boards tied
Suitably braced No sharp edges on tubes Metal Boards tied
Boards suitably supported
Mobile Scaffolding Ladders
(1.2m, min 50mm, max 150)
Height to base ratio Good condition Boards banded
Manufacturers data located 4 in 1
Correctly erected Correct length Design
Wheels lockable and maintained No tubes between rungs Design available
Ladder internal one working lift Rungs tight Design input
Scaffold Ties Class one (Rods under each rung) Rescue
Correct amount 16sqm Maintenance GOTCHA
Correct type Materials serviced Identified in R/Assessment
Load baring fittings used Quarantine area identified Suitable training given
Third Party Protection COSHH DATA located Operatives Aware
Signage Correct PPE supplied Refresher Training
Protection/fans Fall Protection Suspension Loop
Barriers NASC Guidance Emergency kit located
Training WRAPPA Sling Access Hierarchy
CISRS Checked/in date Advanced Guardrail Use of existing structure
NASC SG4:05 Handrail 950mm Staircase
Harness/lanyard Gap does not exceed 470mm Internal ladder to each lift
WRAPPA Suitable Harness/Lanyard Internal ladder to multiple lifts
COMMENTS: External ladder with safety gate
Inspection Reports (f91)
Correctly completed
Checklist on rear
Available for client checks
ACCOMPANIED ON INSPECTION (YES/NO) : BY
HEALTH AND SAFETY REPORT ISSUED BY: (SIGNED) (PRINT)
HEALTH AND SAFETY REPORT RECIEVED BY: (SIGNED) (PRINT)

I R . ISSUED (YES/NO) RECIEVED BY: (SIGNED) (PRINT)

AMBH-HSE-08