Project Name: Project Location:
Completed by: Date:







Scaffold components and planking in safe condition for use and planks graded for scaffold use?      
Competent person in charge of erection and  inspection?      
Tower level and plumb?      
Tower height less than four times the minimum base width?      
Casters of proper size with effective locking devices which are locked when in use?      
Screw jacks extended less than 12"?      
Casters and all frames locked together?      
Guard railing in place on all open sides and ends?      
Horizontal diagonal bracing been positioned properly at base and intermediate levels of 20'.      
Material secured before moving the scaffold?      
Platform fully planked and toe boards provided where necessary?      
Employees removed from the scaffold before it is moved?      
Scaffold free of makeshift devices or ladders to increase height?      
Conditions such as power lines, wind loading, etc. controlled?      
Safe way to get on and off the scaffold without climbing on cross braces?      
Personnel instructed in the safe use of the equipment?