-Contractor Name Period- to

Photo of
Resp Person

5 11

6 -Name
9
-Desig
1

10 2
-Mob No

4 3 4 -Location

SL NO CHECK ITEM PHOTOS Y/N SL NO CHECK ITEMS PHOTOS Y/N

M M
Display board stating the T T
Ladder kept in channels
status of the scaffold ( O.K, W W
1 Th 7 over the jallies in the first Th
Not for use or under
e lift and above.
erection) F F
Sat Sat
Sut Sut

M M
T T
W Each lifts provided with
Scaffold erected in a firm W
2 Th 8 platform (jallies) tied with Th
base ground.
horizontal pipes.
F F
Sat Sat
Sut Sut

M M
Sole plate provide in the T T
base of the scaffold as per W All four side supports pipes W
3 standard (refer note Th 9 (Struts) and properly Th
above).<Full length wooden clamped.
F F
planks/channels> Sat Sat
Sut Sut

M M
Base plate / foot plate of T Interlocking between the T
scaffolds verticals are over W columns & scaffold in case W
4 Th 10 Th
the wooden planks(sole of more than 6 m height
plate) F scaffolds. F
Sat Sat
Sut Sut

M M
T T
W All lifts in the scaffold W
Cup lock locking is not in
5 Th 11 provided with mid rails Th
loose condition.
(hand rails) F
F
Sat Sat
Sut Sut

M Legend
T
Access ladder from the W ---O.K
6 ground & each lift and Th
secured with clamps. F
Sat
Sut
---Not O.K X
Chkd by contractor \ FABS.

Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Signature

Name
 SL NO CHECK ITEMS PHOTOS Y/N
M
T
Four out riggers are W
4 available in four sides of Th
the scaffold e
F
Sa
t
Su
t
M
T
W
Well stable & secured 0.15m
5 Th
platform e
F
Sa
t
Su
t
M
1.1m T
Guard rail has been
provided as per standard. W
6 Th
Mid rail @ 0.55m and 0.55m
e
Guard rail @ 101m F
Sa
t
Su
t
M
T

Proper access way to the W

7 top of the scaffold.(Good Th
Ladder condition) e
F
Sa
t
Sl No CHECK ITEMS PHOTO Y/N Su
t
M M
T T
Display board stating the W
W
status of the scaffold The scaffold width and Th
1 Th 8 3
( O.K, Not for use or e height ratio should be 1:3 e
under erection) F F
Sa
Sa t
t 1 Su
Su t
t
M M
T T
W W
Scaffold erected in a firm Cross barcing has been
2 Th 9 Th
base surface. e
provided in the scaffold e
F F
Sa Sa
t t
Su Su
t t
M M
T T
W W
Availability of wheel lock Height work banner
3 Th 10 Th
in all the four wheels e displayed e
F F
Sa Sa
at t
Su Su
t t
Chkd by contractor \ FABS.

Day Monday Tuesday Wednesday Thurs Day Friday Saturday Sunday

Signature

Name