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Contractor :
Contract No : Date :
REPORT
S/N ITEMS OF VISIT REMARKS
PERMIT
LICENCE
SAFETY MANAGEMENT
RECORDS
REPORT
S/N ITEMS OF VISIT REMARKS
RECORDS (cont'd)
FIRST AID
MOBILE CRANE
TOWER CRANE
REPORT
S/N ITEMS OF VISIT REMARKS
METAL SCAFFOLD
REPORT
S/N ITEMS OF VISIT REMARKS
1) Workers' quarter
2) Hoarding
4) Refuse chute
REPORT
S/N ITEMS OF VISIT REMARKS
OTHERS
1)
2)
3)
INSPECTED BY
NAME
INITIAL/DATE
Copy To:
Contractor :
Contract No : Date :
REPORT
S/N ITEMS BLK STY OF VISIT REMARKS
a) Danger Signboard
c) Information Signboard
5) Barricade
c) to lift opening
6) Safe Access
a) to roof/water tanks
REPORT
S/N ITEMS BLK STY OF VISIT REMARKS
a) pile hoisting
b) pile driving
8) Shoring
9) Safety cover
20) Passenger-Material-Hoist
a) metal gates
b) hoist landing
23) Housekeeping
REPORT
by safe method
26) OTHERS
INSPECTED BY
NAME
INITIAL/DATE
Copy To:
*CONSULTANT/Other :
Contractor :
REPORT
S/N ITEMS OF VISIT REMARKS
REPORT
S/N ITEMS OF VISIT REMARKS
20) Housekeeping
12/24
REPORT
S/N ITEMS OF VISIT REMARKS
OTHERS
21)
INSPECTED BY
NAME
INITIAL/DATE
Copy To:
*CONSULTANT/OTHERS* : ________________
Contractor :
Contract No : Date :
REPORT
S/N ITEMS BLK OF VISIT REMARKS
1) FOUNDATIONS
2) SOLEPLATES
3) BASEPLATES
Proper baseplates fitted to all standards or
legs of scaffold
4) FOOT - TIES
Foot-ties fitted to both inner and outer
standards
5) ALIGNMENT OF SCAFFOLD
COMPONENTS
6) TORSION CABLE
Tensioned torsion cable at every
cantilever bracket and C-channel
8) FRAMES
a) Standards connected end to end with
either sleeve couplers or joint pins
13) LADDER
Ladders are securely attached to the
scaffold for access
a) WARNING SIGNBOARDS
Warning signboards stating "Caution. Do
not use the scaffold." in 4 official
languages placed at strategic locations
b) TIE BACKS
c) BARRICADES
OTHERS
26)
INSPECTED BY
NAME
INITIAL/DATE
Copy To:
*CONSULTANT/Other : _________________
Contractor :
Contract No : Date :
REPORT
S/N ITEMS BLK OF VISIT REMARKS
2) Protective hoardings/barricading
at ground floor.
a) Workers/Riggers anchor
safety harness to independent
lifeline
OTHERS
18)
* _/ = Satisfactory/Yes X = Not provided/Not satisfactory/Inadequate/No
NA = Not Applicable - = Briefing Remark/Advice
INSPECTED BY
NAME
INITIAL/DATE
Copy To:
* CONSULTANT/Other :
Contractor
Contract No Date :
REPORT
S/N ITEMS BLK OF VISIT REMARKS
20) Housekeeping
OTHERS
21)
INSPECTED BY
NAME
INITIAL/DATE
Copy To:
*CONSULTANT /Other :
CONTRACTOR