Please enable JavaScript in your browser to complete this form.Job No *Site Address *Supervisor Name *Please SelectDaniel GriffithsAndrew CaddeyBrandon CalderDavid ClarkePatrick KeaneJason BrunnerJames CutlerDaniel PrideMichael BrennansMark WoodsMyles FieldStephen WagstaffDonald GatesLindsay FrizellJohn VosJohn AbdallahGreg StocksBrett LarmanTroy CoopeDate / Time *DateTime Refer to Guides & Codes Of Practice web links enclosed What type of system is in place on this site? *Full Scaffold ground upLower roof walkwayPerimeter fall protectionMobile ScaffVoid protection“A” Frames & planksPhoto UploadPhoto of systemPhoto Upload Photo of systemPhoto Upload Photo of systemIs the Handover Certificate clearly displayed at the ladder access point? *YesNoMake sure the certificate is current within 30 days, otherwise have it reinspect.Comments/Action Required *Photo UploadNon compliant photoPhoto UploadNon compliant photo Is the scaffold erected on solid and even foundations? *YesNoNot ApplicableReference for information page 10 of below link General guide for scaffold work https://www.safeworkaustralia.gov.au/scaffolds-scaffolding-work-general-guide.pdf Comments/Action Required *File UploadNon compliant photoFile Upload Non compliant photoFile UploadNon compliant photoAre intermediate decks in place (every 2.0 metres)? *YesNoNot ApplicablePage 11, of the General guide for scaffold work, see above linkComments/Action Required *File UploadNon compliant photoFile Upload Non compliant photoFile UploadNon compliant photoAre the gaps between the scaffold platforms and building edge/face no greater than 225mm? *YesNoNot ApplicableMeasured horizontally, See page 11 of above linkComments/Action Required *File UploadNon compliant photoFile Upload Non compliant photoAre the gaps between the hop-ups/ decks and building floor no greater than 300mm? *YesNoNot ApplicableMeasured vertically, see page 34 Scaffolding code of practice below https://www.worksafe.qld.gov.au/scaffolding-cop-2021.pdf Comments/Action Required *Photo UploadNon compliant photoPhoto Upload Non compliant photoAre there any missing ledgers, planks or hop-ups, braces and ties? *YesNoNot ApplicableComments/Action Required *Photo UploadNon compliant photoPhoto UploadNon compliant photoIs there safe access to each working deck? *YesNoNot ApplicablePage 15 of the General Guide for Scaffold WorkComments/Action Required *Photo UploadNon compliant photoPhoto Upload Non compliant photoIf a ladder access is installed, is edge protection/hatch provided at the void? *YesNoNot ApplicableComments/Action Required *Photo UploadNon compliant photoPhoto UploadNon compliant photoAre all handrails & Mid rails installed? *YesNoNot ApplicableTo prevent falls of peopleComments/Action Required *Photo UploadNon compliant photoPhoto UploadNon compliant photoAre all toe boards/brick guards installed? *YesNoNot ApplicableComments/Action Required *Photo Upload Non compliant photoPhoto Upload Non compliant photoAre all lap boards lashed and secure? *YesNoNot ApplicableUse of plastic Zip ties are not approved to secure structural elements in scaffold, see page 23 Code of Practice, previous link.Comments/Action Required *Photo UploadNon compliant photoPhoto UploadNon compliant photo Is the working deck clear of materials to provide safe access? *YesNoNot ApplicablePlatform clear access must be a minimum 450mm wideComments/Action Required *Photo UploadNon compliant photoPhoto UploadNon compliant photoSupervisor Signature Clear Signature Submit
