Whsmp · OPW16/0021

                                                                           Monthly Scaffold Inspection Checklist
                                                                                                                          HB-HSEQ-F-061
                                                                                                                              Version: 5


Form to be used for  box


    As part of Handover Certificate                                           Monthly Maintenance Checks on Scaffold

Area: _____________________             _    ____                         Date: ______________________                ____

Level: ______________________                ____                         Grids: ______________________                  ____
DOCUMENTATION
                                                         check                                                                  check
                            ITEM                                                          ITEM
                                                         Yes/No                                                                 Yes/No
Are scaffold drawings designed by an engineer or                  The Scaffold Safety Plan / Safe Work Method
scaffold designer? Showing elevations, sections and               Statements for the safe erection and dismantling
general arrangement of scaffold and has been                      and handling of the scaffold is being implemented
designed to comply to AS 1576 Scaffold and AS                     to erect the scaffold
1576.1 General Requirements?

SCAFFOLD VICINITY
                                                         check                                                                  check
                            ITEM                                                          ITEM
                                                         Yes/No                                                                 Yes/No
Has public protection been provided during                        Is there sufficient control of vehicle movements?
erection and dismantling?
Have sufficient safe guards been provided against                 Is there sufficient control over crane movements?
electric power lines (within 4 metres)?

SUPPORTING STRUCTURE
                                                         check                                                                  check
                            ITEM                                                          ITEM
                                                         Yes/No                                                                 Yes/No
Is the condition of the supporting structure sound                Is there a risk that the supporting structure will
and of adequate strength to support the scaffold                  change and affect future scaffold installation?
structure?

SOLEPLATES AND BASEPLATES
                                                         check                                                                  check
                            ITEM                                                          ITEM
                                                         Yes/No                                                                 Yes/No
Is the scaffold built on solid ground, if not are sole            Are the base jacks supporting every standard?
plates used to distribute the load
Are the sole plates the correct size and number to                Are the base jacks installed correctly and not
support the scaffold?                                             extended too high?
Are the sole plates hardwood timber and in good                   Are the base jacks centred over the sole plates and
condition?                                                        secure from moving?
Are the sole plates secure and placed so they can’t
dislodge

SCAFFOLD STRUCTURE
                                                         check                                                                  check
                            ITEM                                                          ITEM
                                                         Yes/No                                                                 Yes/No
Are the standards bearing firmly, plumb and as per                Are the lifts at the correct height and as per plan?
design?
Are the joints in standards correctly staggered and               Are the ties placed and fixed correctly as per
secure to suite design?                                           design?
Is the bay and end bracing installed correctly as per             Is the maximum vertical gap between the hop up
design?                                                           and the slab 300mm or less?

PLATFORMS
                                                         check                                                                  check
                            ITEM                                                          ITEM
                                                         Yes/No                                                                 Yes/No
Does the scaffold have the required working                       Is there adequate edge protection, containment
platform and located as per design                                screens to all platforms and ends?
Are catch platforms correctly installed and at the                Are decks placed and secured correctly into

                                                                                                                            Page 1 of 2