SCAFFOLDING ERECTION & INSPECTION RECORD

LOCATION:_________________________________________________
REF No :___________________________________________________
DATE ERECTED : ____________________________________________
REQUESTED BY :
__________________________________________________________
__________________________________________________________
BUILT BY : _________________________________________________
NAME COMPLETE PERSON
:_________________________________________________________
SIGNATURE: _______________________________________________

SCAFFOLD TO BE USED
Light Duty 255 kg
Medium Duty 450 Kg
Heavy Duty 675 kg
THE ABOVE WEIGHT ARE FOR ANY
ONE WORKING PLAT FORM BY
AND INCLUDE MEN AND MATERIALS

CAUTION
THE FOLLOWING HAZARDS
SHOULD BE NOTED
 BY LAW REMOVAL OR INTERFERENCE
WITHOUT PERMISION WILL MAKE
YOU LIABLE TO PROSECUTION
INSPECTION FREQUENCY
BY
COMPETENT PERSON
DATE TIME SIGNED
Date/Month/Years 09.00 13.00 19.00 I II III

19.00 22.00 24.00

09.00 13.00 19.00

19.00 22.00 24.00

09.00 22.00 19.00

19.00 22.00 24.00

COMMENT : _____________________________________________

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