10 " 12 13 14 15 16 7 on the scaffold ? Dow AgroSciences India Pvt Ltd LOTE SITE SCAFFOLDING CHECK LIST Scaffolding No - Facility Location Date Is the scaffold erected on solid firm leveled ground ? if not, were planks ( other than scaffolding plank) laid down under uprigh!s ? Is there base plate under all upright legs of the scaffold ? Is the base away from all excavations, drain covers, manholes etc. Is the scaffold braced diagonally to stop swaying Is the scaffold braced diagonally in the horizontal plane, every 10 ft. to prevent see - sawing ( this is mandatory on rolling scaffolds ) ? Is this a rolling scaffold & less than 30 ft? Does the rolling scaffold have locking castors / wheels ? The height, inclusive of railings, of every mobile scaffold used for work is ot more than 3 times, the lesser of a base dimension of such scaffold. The Mobile saffold is used only on plain and even surface Are the planks secured against slipping ? Are the planks as follows - Max. span 1.2 mtr/ 4.8 mtr /2.4mtr/3 mtr /4 mtr and all are 1.5” thick. {f the working platform is over 10 ft, is the access ladder caged in ( or i the middle of the scaffold )? Does the ladder extend at least 3 ft beyond the working platform ? Is the working platform protected by top handrail ( not more than 42" nor less than 36" from the working platform) and a middle rail (anywhere between top handrail and platform) and kick plate ? If the working platfornt is over 30 ft from the ground, is there a rest platfcrm included in the scaffold ? Does the access ladder from the rest platform start at a different location | YES iO N/A WLLE ci18 19 20 2 23 24 25 26 ‘Are all connecting pieces properly installed (clamps, pins, locking arms. etc.) If the scaffolding is 3 times higher than its smallest width, is it secured at the proper intervals (i.e.. 5 ft width secured at 15 ft & 30 ft) Ian extension ladder (30ft or less) is used for access , is it tied off at the top and bottom of the scaffold ? If scaffold is obstructing any pathway (access/egress routes), is the Barricading/Waring signs installed? Does the scaffold obstruct the easy access to emergency equipment like, Fire call point, Eye shower, Fire hydrant point etc. and Emergency e» Is the scaffold straight and plumb ? ‘When erection is complete has the "DO NOT USE SCAFFOLD" red tag been hung ? Has the scaffold been inspected by a competent person and a "SAFE SCAFFOLD" green tag been hung ? Is the Sr No tag # & date of erection on the scaffold so it can be easily found ? Sacffold inspected by Signature: ‘Scaffold Valid Up to Date: YES NO NA. [ 5 Scaffold Approved by: Signature