SCAFFOLDING INSPECTION CHECKLIST

Doc Ref: TEP-930-PRC-HS-BP4-0001 TANGGUH EXPANSION – PROJECT DEFINE Form no :FORM-TEP-HSSE-122

Date: LNG EPC Revision: 0

DATE : DAY SHIFT : YES NO NIGHT SHIFT YES NO

WEATHER: CLEAR CLOUDY RAIN

MAIN ACTIVITIES

LOCATION :

Conformance
ITEM C NC NR Remarks / Comment

FOUNDATION

1 Prepare & level foundation

2 Sole, plates ,covering two support on soft grounding

TUBULAR

No distortion , no cuts or holes & no bents or

3
flattering

DECKING / BOARDS

4 Close boards to prevent toes / nuts dropping through

5 Tied down against wind and not split or cracked

TOE BOARDS

All rounds protection againts objects falling and

6
minimum high 15cm

GUARDS RAILS

7 Security fastened and 90 cm to 120 cm high

8 Gap between toe board and first rail not more <76cm

9 Access ladder Set at 75°

Is the proper access for ladders ? Are ladder secure

at least at the top ?

PERSONNEL and TAG Personnel and Tags

Are scaffold constructed by competent and certified

10
personnel

11 Is the scaffold inspector certified

12 Are safety harnesses used when required ?

Are proper scaffold entry tag ( green / red) used to

13 inform personnel when it is safe
(or not safe) to use a scaffold ?

NO FOTO FINDING RECOMMENDATION / FOLLOW UP

Remarks / Keterangan : Inspected by,

C Conform
NC = Not Conform
NR = Not Required
Name : Position SIGN :

Additional Info :