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Document n°

Issue date 06.10.2022


Checklist for Scaffolding Rev n°
Rev. Date

Project Doc. No. :


Client contractor :

SITE : LOCATION : DATE :

PURPOSE : TYPE :

YES NO NA

1 All scaffold components in place and no defects?

2 Competent person in charge of erection/inspection?

3 Mud Sills properly placed and adequate sized when required?

4 Screw jacks being used to level and plumb scaffold when required?

5
Base plates and/or screw jacks in firm contact with mudsills and frame?

6 Scaffold is level and plumb?

7 Scaffold legs braced, with braces properly attached?

8 Guard railing in place on all open sides and ends?

9 Visual check to verify clamps secured in place?

10 Scaffold secured to structure to prevent movement?

Brackets, tube and clamp, and accessories properly placed with wedges
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tightened?

12 Area around scaffold has been secured/roped off?

APPROVAL / REMARKS of Quality Assurance Engineer:

Signature - CONTRACTOR Date Signature - CLIENT Date


Checked By: Checked By:
Approved By: Approved By:

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