Scaffolding checklist

NAME Date
AREA/LOCATION Scaffolding Tag number
No WOK PERMIT,SCAFFOLD DESIGN /PLAN/CALCULATION YES No
1 Is the scaffold categorized as special scaffold?
2 If the scaffold is special scaffold ,was it provided w/ approved Design plan and calculation
3 Work permit has attached scaffold request form, J S A, M S( if applicable)
4 Scaffold to be erected near un-insulated/insulated power lines.
5 Scaffold to be erected near excavation (distance set in yanbu 3 is complied )
6 Permit issuer & certified scaffold supervisor is present during erection ,dismantling & modification
NO SCAFFOLD TAG
1 Scaffold have scaffold tag near the point of access properly fitted and secured with coupler
2 Is the scaffold tag properly filled up by supervisor / inspector (No. of total planked & working platform?
3 The inspector date of the scaffold tag is updated (every 14 days)?
No SCAFFOLD MEMBER /COMPONENTS
1 Sill bored are used to support scaffold on soft surfaces with base plate ?
2 Screw jack is not adjusted more than 2/3 of its threaded length?
3 Post standards are plumb and level and the lift height is not more than 2 meters?
4 If tube and coupler scaffold is used is the post standards connection is not on the same bay and lift?
5 Are the tubes and couplers used having no defects?
6 Post standard for light duty is not more than 1.2 meter ×2.7 meter apart ?
7 Post standard for medium duty is not 1.2 meter ×1.8 meter apart ?
8 All working level is fully planked and no gaps can be found more than 1 inch
9 Wood planks are free from damage ,decay ,defects ,crack, bent and twist
10 Planks are firmly secured against movement at both sides ?
11 Planks extending their end support not more than 6 inches to maximum of 12 inches
12 End of planks are properly supported end to end
13 Top rails ,mid rail, toe board on all open sides are installed ?
14 Guardrails and toe boards are fixed inside of support post?
15 Ties guys or raker is provided if the scaffold is 4 times the minimum base dimension
16 Scaffold is vertically braced and in the full length of scaffold
17 Braces are attached as close as possible to post , runner , bearer interconnection ?
18 Working platform has access by ladder ,stair ,ramp or walkway ?
19 Ladder is placed 75 degrees (4:1) or if ladder is vertical is it properly attached in the top ,middle,bottom?
20 Ladder extend at least 1 meter or at least 3 rungs above the landing platform
*for the complete checklist pleas use the scaffold user’s safety checklist found at
the back of scaffold tag
HSE DEPARTMENT