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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,

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