Scaffold Inspection Form
Date of Inspection:
Time:
Location of Scaffold:
Inspected by (Designated Competent Person):
BEFORE USING THE SCAFFOLD-
Has this work location been examined before the start of work operations and have all the appropriate precautions
been taken?
e.g. checking for: overhead objects, falling or tripping hazards, uneven ground, opening onto a door.
Will fall protection be required when using this scaffold?
Has the scaffold been setup according to manufacturer’s instructions?
General Rules for All Scaffolds
YES
NO
N/A
Scaffold components can support at least four times their maximum intended load.
Scaffold is fully planked- No more than 1” gap between planks.
Platform is at least 18 inches wide (12 inches on pump jacks).
Guardrails are used or personal fall arrest system is used, if work height is >10 feet.
Guardrail system: Toprail Midrail Toeboard Posts
Scaffold is 14” or less from face of work, if workers remove front guardrails (18” for
plasterers).
Planks do not extend past the ends of the scaffold frames more than 12 inches.
Casters are locked before work begins.
Work platform free of clutter, mud, snow, oil or any tripping hazard.
Minimum power line clearance (10 feet)
If the scaffold is defective, has it been removed from service and tagged out?
General Rules for Supported Scaffolds
Height to base width ratio is: Less than 4:1 (no guying, ties, or braces required)
Over 4:1 scaffolds are restrained from tipping by guying, tying, or bracing.
All scaffold frames and uprights use base plates (mud sills required if on dirt)
Footings are level, sound, and rigid. No settling has occurred.
Unstable objects such as blocks, bricks, buckets, etc. are not used as work platforms or to
support scaffolds.
Are riggers secured and installed correctly?
General Rules for Access
No more than 2’ step up or down or a 14” step across to get on or off a platform.
Ladder first rung is not more than 24” above the ground.
Hook-on and attachable ladders are designed for the scaffold.
Add-on ladders must have a rung length of at least 11 ½”
Built in ladders (part of the scaffold frames) must have a rung length of at least 8”.
Rungs line-up vertically for the entire height of the scaffold.
Cross braces are not used for climbing up or down from the scaffold.
Scaffolding is complete and compliant per OSHA Standards and safe to use
Scaffolding is incomplete. DO NOT USE!
Signature of Competent Person: _________________________________________ Date: ___________________
©2017 SFI Compliance, Inc. Version 1.0 SAFETY & HEALTH PROGRAM
