Leidal & Hart Safety App

Location

Scaffold Type

Contractor

Supervisor

Date of Inspection

Competent Person

Have scaffold components been inspected and are free of defects?

Yes

No

N/A

Are scaffold components compatible and not intermixed?

Yes

No

N/A

Have scaffold planking been inspected and are graded for scaffold use?

Yes

No

N/A

Is scaffold planking free from defects (i.e. cracks)?

Yes

No

N/A

Is scaffold level and plumb?

Yes

No

N/A

Are base plates and/or screw jacks in firm contact with sills and frame?

Yes

No

N/A

Has all scaffold legs and uprights been properly braced? (i.e. cross bracing)

Yes

No

N/A

Are all connections secured?

Yes

No

N/A

Has scaffold been erected to support not less than 4 times the maximum intended load?

Yes

No

N/A

Has the scaffold been erected under the supervision of a competent person qualified in scaffold erection?

Yes

No

N/A

Has proper access been provided?

Yes

No

N/A

Are guardrails in place on all exposed sides and ends above 6'?

Yes

No

N/A

Is personal fall arrest equipment provided in areas not protected by guardrail systems (i.e. open gates, window openings)?

Yes

No

N/A

Have toe boards been installed properly?

Yes

No

N/A

Have the following hazardous conditions been assessed?

Yes

No

N/A

Power lines

Yes

No

N/A

Wind Loading

Yes

No

N/A

Uplift

Yes

No

N/A

Are working level platforms fully planked between guardrails?

Yes

No

N/A

Does planking have a 6" to 12" overlap beyond its support bearers?

Yes

No

N/A

Are scaffold platforms at least 18" wide?

Yes

No

N/A

Is planking secured at the end bearers?

Yes

No

N/A

If a free standing scaffold, the scaffold height shall not exceed 4 times the minimum base dimension

Yes

No

N/A

If used next to an adjacent structure, has the scaffold been tied to the structure at least every 30' in length and 26' in height?

Yes

No

N/A

Have all personnel been instructed in the safe use of the equipment?

Yes

No

N/A

Have all personnel been trained by a qualified person in scaffold safety?

Yes

No

N/A

Any Actions Taken

USE FOR FORD HUB PROJECT ONLY

Scaffold Erection Inspection Checklist

Scaffold Erection Inspection Checklist - FORD HUB ONLY

(810) 629-1504