1. Scaffold components not rusted. _____

2. No damaged welds or cracking.  _____

3. No bends or kinks in scaffold components. _____

4. Locking devices and braces in good condition.  _____

5. Coupling pins straight.  _____

6. Cross bracing straight with center. Pivot in place.  _____

7. Casters in good condition with operable brake.  _____

8. Guardrails in good repair and components in place.  _____

9. Platforms fully planked.  _____

10. Gaps less than 1 inch between platform and uprights.  _____

11. Platforms at least 18 inches wide.  _____

12. Front edge of platform less than 14 inches from face of work.  _____

13. Ends of platform extend over the support rod by at least 6 inches unless cleated or restrained by hooks.  _____

14. Support legs rest on secure foundation.  _____

15. Footing is level and rigid and capable of supporting scaffold without settling.   _____

16. Support legs are plumb and braced to prevent swaying.  _____

17. Ladders, stairways, or ramps are used.  _____

18. Cross bracing is not being used as a means of access.  _____

19. Clearance between the scaffold and power lines is adequate.  _____

20. Snow, ice or other slippery material is not on the scaffold.  _____

21. Debris on the scaffold is not excessive.  _____

22. Employees are wearing hardhats.  _____

23. The area below the scaffold where objects could fall has been barricaded or a toeboard has been erected. _____

24. If materials are piled higher than the toeboard, screening has been erected.   _____

25. All workers have been properly trained . _____

Competent Person _____________            Date ________