Project Name: Project Location:
Completed by: Date:







Scaffold components and planking in safe condition for use and planks graded for scaffold use?      
Frame spacing and sill size capable of carrying intended loading?      
Competent person in charge of erection and to inspection?      
Sills properly placed and adequate sized?      
Screw jacks been used to level and plumb scaffold instead of unstable objects?      
Base plates and/or screw jacks in firm contact with sills and frame?      
Scaffold is level and plumb?      
Scaffold legs braced with braces properly attached?      
Guard railing in place on all open sides and ends?      
Overhead protection or wire screening been provided where necessary?      
Scaffold been tied to structure at least every 30' in length and 26' in height?      
Free standing towers been guyed or tied every 26' in height?      
Brackets, tube and clamp,  and accessories been properly placed with nuts and bolts tightened?      
Scaffold free of makeshift devices or ladders to increase height?      
Planks have minimum 12" overlap and extend 6" beyond supports?      
Toe boards properly installed?      
Conditions such as power lines, wind loading, etc. controlled?      
Safe way to get on and off the scaffold without climbing on cross braces?      
Front face within 14 inches of the work or within three feet for outrigger scaffolds?