| Jobsite: |  |  |  | Project Number: |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Competent Person: |  |  |  | Scaffold Description: |  |  |  |  |
| Pre-shift inspections shall be made by a competent person BEFORE each shift. |  |  |  |  |  |  |  |  |
|  | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday |
| Date: |  |  |  |  |  |  |  |  |
| Time: |  |  |  |  |  |  |  |  |
| Inspector Initials: |  |  |  |  |  |  |  |  |

**For each “Inspection Item,” indicate one of the following: P=Pass F=Fail or N/A=Not Applicable**

| INSPECTION ITEM | M | T | W | Th | F | S | Su |
| --- | --- | --- | --- | --- | --- | --- | --- |
| Was this scaffold designed by a qualified and experienced person? |  |  |  |  |  |  |  |
| What is the maximum intended load of this scaffold? |  |  |  |  |  |  |  |
| Is the scaffold designed to hold 4 times the maximum intended load? |  |  |  |  |  |  |  |
| Was a competent person present during erection, modification, and dismantling? |  |  |  |  |  |  |  |
| Are all scaffold components in good condition or replaced before use? |  |  |  |  |  |  |  |
| Are all uprights erected on sound footings (base plates and mud sills)? |  |  |  |  |  |  |  |
| Are all uprights plumb and rigidly braced against movement? |  |  |  |  |  |  |  |
| Are all uprights accurately spaced based on scaffold load rating? |  |  |  |  |  |  |  |
| Do horizontal runners extend the length of the scaffold at the same height? |  |  |  |  |  |  |  |
| Are all runners connected to all posts? |  |  |  |  |  |  |  |
| Are the lowest horizontal runners as close to the bases/mud sill as possible? |  |  |  |  |  |  |  |
| Is the maximum vertical space between horizontal runners 6' 6" inches? |  |  |  |  |  |  |  |
| If diagonal bracing is required, is it installed as the correct spacing intervals? |  |  |  |  |  |  |  |
| If diagonal bracing is required, is it installed at the correct angles? |  |  |  |  |  |  |  |
| If diagonal bracing is required, does it from bottom to top in continuous line? |  |  |  |  |  |  |  |
| If diagonal bracing is required, does a new line of bracing start every 5th post? |  |  |  |  |  |  |  |
| If the scaffold is tall enough, is it tied to the building with #9 wire or better? |  |  |  |  |  |  |  |
| If required, is the scaffold secured every 30' horizontally and 26' vertically? |  |  |  |  |  |  |  |
| Are all working levels fully planked with only minimal gaps between planks? |  |  |  |  |  |  |  |
| Are all planks made of suitable material (scaffold grade lumber, metal planks)? |  |  |  |  |  |  |  |
| Are all scaffold planks secured (cleats, hooks, #9 wire, or 12" of overlap)? |  |  |  |  |  |  |  |
| Is an access ladder provided to all working levels? |  |  |  |  |  |  |  |
| Are guardrails and midrails provided to all open sides? |  |  |  |  |  |  |  |
| Are 4" toe boards provided on all open sides? |  |  |  |  |  |  |  |
| Is falling object protection provided (mesh screening, paneling, canopies, etc.)? |  |  |  |  |  |  |  |
| Are slippery conditions (ice, oil, etc.) removed as soon as possible? |  |  |  |  |  |  |  |
| Are employees prohibited from using scaffolds during high winds? |  |  |  |  |  |  |  |
| Are tools, materials, and debris removed to prevent accumulation? |  |  |  |  |  |  |  |