Ref.

#: CMO-F-056
Rev. #: 0
Rev. Date: 01 July 2015

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SCAFFOLD INSPECTION SAFETY CHECKLIST

PROJECT NAME : _____________________________________________________________

EXACT LOCATION OF SCAFFOLD: ________________________________________________________
CONTRACTOR : _____________________________________________________________
SCAFFOLD SUPERVISOR : _____________________________________________________________
TYPE OF SCAFFOLD: MOBILE/SUSPENDED/GROUND AREA OF ERECTION: __________________________

Insp.
DESCRIPTION YES NO REMARKS/COMMENTS
Point
Is the scaffold frame in good conditions? [no
1
rust/no paint]
Is the ground where the scaffold is to be erected
2
firm and not water logged?
Have any open excavation near to the scaffold
which may endanger its stability or access been
3 noted and allowed? If, future excavation which may
endanger the scaffold; have safety precaution been
taken up?
Have any overhead hazards such as power
4 transmission lines telephone wires, etc., in the
vicinity of the scaffold been noted and allowed?
Do you know the purpose for which the scaffold is
5 to be used for; Light duty? Medium duty? Heavy
duty?
Are the erectors supplied with personal safety
protection devices such as full body harness with
6
shock absorber, life lines, working gloves, hard hats
and etc., and use the devices?
Is there a competent erector to supervise the
7 erection of the scaffold? [with training certificate
accredited by DOLE/BWC]
Have warning signage stating CAUTION: DO NOT
USE THE SCAFFOLD or EXCLUSION ZONE had been
8
fixed in prominent position while erection is in
progress?
Where the scaffold is not erected on to a solid
9 ground, have soil board been place and are they of
the correct thickness and lengths?
10 Have all standards been fitted with base plates?
Ref. #: CMO-F-056
Rev. #: 0
Rev. Date: 01 July 2015

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Are the scaffolds plumb but slightly lean-in towards
11 the structure they are servicing? Is there provision
for base jack to adjust plumb of scaffold?
Are the transom and ledgers standards connections
12
using right angle couplers?
Is the scaffold has provision for secondary outrigger
13
support?
Are the access ladder firmly supported at their base
14
to prevent soil settlement?
Is the scaffold connected to any rigid structure to
15
prevent collapse?
Has a professional engineer been consulted on
whether the removal of the connecting temporary
16
structure will affect the strength or stability of the
scaffold?
Have any hazards been identified that may affect
17
workers on the scaffold been noted?
Is the scaffold complete with guardrail, toe board
18
and provision of lifeline?
Are the results of the inspections recorded and
19
implemented?

I/We hereby commit to check/inspect daily in accordance with the above checklist and adhere to implement
standards policies and procedures, relating OSH Standards.

INSPECTED BY: __________________________________________ NOTED BY: _____________________________________

Designation/ Print name/signed Designation/ Print name/signed

DATE OF INSPECTION: ___________________________________ DATE: _________________________________________