SCAFFOLD PLAN COMPLETENESS CHECKLIST
Scaffold Location J Description.
SECTION A: FOR SCAFFOLDS OVER 122 m (404) TALL, CHECK TO INDICATE IF IN SCAFFOLD PLAN:
Y scope of Work
3H ‘Grief deneription of work to be performed from the anafiolé
SA Form #9013
B[] Oration of work
\Sonfold Drawings
2a[] Hecht of seatold shown
20[7] _Lenge and wcth of scaffold at base shown
se[7] Type of scatfeld (ube & coupler. fabricate tubular frame, system, ets) noted
25 [7] Upht duty. Medium-duty. or Speciatduty load rating noted and weed lor detign of xaffald
[EF] tacmum intendeatoad (personnel equioment, too, and materials) per worming level noted
“Total number of plenkedipiaiowmed levels noted
Maximum number of working levels notes
Tubing S28 (Glameter wall uoxness) and matenal specrBeaton (inctuaing Vie stress) noted
Platiorm unks ‘ype. size, and material specited
Oramings aderqiainly chow semplein exrctrvcton tnommation aid Satie forthe seaiioht
~ Posts, bearers. runners. hoazental (plan) and verbal Bracing. 80
= attachments or es te buildings or ober structures
+ Ladders or other ascess to all working lavels
Guardrail system loeatons, dimensions. ané tepraii midral and teaboars eizee
7 Base suppor details, including base plates and sis
Orawn to seals on at least “C* sine paperand soste noted on drawings
Seaflold Rly and propery dimensioned
Fan views Stow complete layout of al horizontal members (bearers, sunners. hore. Bracing. ete.)
Elevation views show complete layout ofall vertical members (posts. braces. eto)
All potential obstructions and itactorencee (piping. cable Wye. pattorme. ote } shown and cloared
{Al areas to remain free of eatiod ebstrustons shown (roads. comidors,