Checksheet For Scaffold
Contractor Name- Period- to Date Time
3
Contractor Name
7
7
Supervisor -Name-
8
8
5 11 Desig-
6
9 Mob No-
10 2
Location-
10
44 3 4
SL NO CHECK ITEM PHOTOS Y/N SL NO CHECK ITEMS PHOTOS Y/N
Display board stating the
Ladder kept in channels
status of the scaffold (
1 7 over the jallies in the
O.K, Not for use or under
first lift and above.
erection)
Each lifts provided with
Scaffold erected in a
2 8 platform (jallies) tied
firm base ground.
with horizantal pipes.
Sole plate provide in the
base of the scaffold as
All four side supports
per standard (refer note
3 9 pipes (Struts) and
above).<Full length
properly clamped.
wooden
planks/channels>
Baseplate / foot plate of Interlocking between the
scaffolds verticals are columns & scaffold in
4 10
over the wooden case of more than 6 m
planks(sole plate) height scaffolds.
All lifts in the scaffold
locking system is not in
5 11 provided with mid rails
loose condition ?
(hand rails)
Access lader from the
6 ground & each lift and 12
secured with clamps.
Scaffolding Supervisor
NAME SIGNATURE DATE
NAME SIGNATURE DATE
Safety Dept.
Classified - Internal use