Independent Scaffold Inspection Checklist: No Inspection Items Specification Remark's Good Poor 1 Base

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INDEPENDENT SCAFFOLD INSPECTION CHECKLIST

Date Inspection :
Type of scaffold : Independent (Tube & Coupler)
Duties of scaffold : 1. Light Duty 2. Medium Heavy Duty 3. Heavy Duty
Purpose of scaffold :
Location :
Name of Scaffolder : 1.________________________ 3.________________________
2.________________________ 4.________________________
No Inspection Items Specification Remark's
Good Poor

1 Base - Ground
- Concrete
- Base Plates
- Adjustable base plates
- Planking / Matting
- Leveling
2 Standard - Pipe Diameter
- Length
- Levelling (vertical)
- Couplers
- Pins / Sprockets/Sleeves
3 Ledger - Pipe Diameter
- Length
- Levelling (vertical)
- Couplers
- Pins / Sprockets/Sleeves
4 Transom - Pipe Diameter
- Length
- Levelling (vertical)
- Couplers
5 Putlog - Pipe Diameter
- Length
- Levelling (vertical)
- Couplers
6 Bracing Face Brace
- Pipe Diameter
- Length
- Couplers
End Brace
- Pipe Diameter
- Length
- Couplers
Date Inspection :
Type of scaffold : Independent (Tube & Coupler)
Duties of scaffold : 1. Light Duty 2. Medium Heavy Duty 3. Heavy Duty
Purpose of scaffold :
Location :
Name of Scaffolder : 1.________________________ 3.________________________
2.________________________ 4.________________________
No Inspection Items Specification Remark's
Good Poor

7 Guard Rail Ledger Guard rail


- Pipe Diameter
- Length
- Levelling
- Couplers
Transom Guard rail
- Pipe Diameter
- Length
- Levelling
- Couplers
8 Platform - Planking Condition
- Width
- Length
- Clearance (Plank to Plank)
- End to end roping
- Deflection
9 Toe Board - Planking Condition
- Height
- Clearance
- End to end roping
10 Ladder Allumunium
- Condition
- Height
- Putlogs/Roping ties
- Angle
Pipe Ladder
- Nominal Diameter
- Condition
- Heigth
- Putlogs/Roping ties
- Angle
- Couplers
11 Gin Wheel - Condition
- SWL
Date Inspection :
Type of scaffold : Independent (Tube & Coupler)
Duties of scaffold : 1. Light Duty 2. Medium Heavy Duty 3. Heavy Duty
Purpose of scaffold :
Location :
Name of Scaffolder : 1.________________________ 3.________________________
2.________________________ 4.________________________
No Inspection Items Specification Remark's
Good Poor

- Safety Couplers
- Safety Catch
- Hoist Rope

12 Tie In Permament Structure


- Condition and Strenght
- Pipes and Couplers

Building
- Condition and Strenght
- Bridles
- Couplers

13 Access Ladder Access/Manhole


- Chain Standards
- Chain Condition
- Landing Platform
Materials Access
- Chain Standards/Tube
- Chain/Tube Condition
14 General Surface - Leveling
- safety

SAFETY RECOMMENDATION
1. The People work install scafollding must use full safety harness and PPE
2._________________________________________________________________
3._________________________________________________________________
4._________________________________________________________________

Inspected By : Signature By :

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