Erector/Competent Person: Complete (Competent Person signature)
Date Item Check Special Conditions/Additional Controls Scaffold components are in good condition.
Scaffold connections are secure.
Scaffold is level and plumb; resting on base plates
(supported scaffold) and a firm foundation.
Cross bracing is installed between scaffold legs.
Scaffold is constructed to support the maximum intended
load (1:4) Wheel locks are operable on mobile scaffold.
Plank installation is correct and secure.
Overlap is a minimum of 12 inches, and extends 6 to 12
inches past the sill for the continuous run of planking. Work platform fall protection: ■ Fully planked ■ Top rail (36 to 45 inches) ■ Mid rail (approximately cantered) ■ Toe boards ■ Access Structure is stabilized against tipping if necessary. Secure at the nearest horizontal bar as follows: ■ Initially, secure at a height 4 times the minimum base dimension. ■ Periodically, secure every 26 feet unless the narrow dimension is 3 feet or less - then secure at 20-feet increments. ■ Secure at the nearest vertical bar every 30 feet of length. Scaffold status tag is completed and attached near the access point. Other Remarks: