INDUS MOTOR COMPANY LTD.

Scaffolding Inspection Checklist Legend: O OK X N/G r N/A

Equipment Number : Inspection Tag Issued By:

Month: Expiry Date of Inspection Tag:

Date
ITEM INSPECTED
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
S.No Comments
Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re Re
Red
Yello Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel Yel
Scaffold frame d
Gree
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Green low low low low low low low low low low low low low low low low low low low low low low low low low low low low low low
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1 Footing stable, level

2
All parts of the scaffold are free of
corrosion
3 Inspected periodically

4
Scaffold frame is level and plumb on all
sides
5
Planks proved as per requirement
2''x10''x10'
6
Guard rail height up to 36 to 42 inches
from platform
7 No cable or rope rails provided

8
Ladders provided and extend 3 ft. above
platform
9 Plank provided (1'' x4''x10')

10 Ladder properly constructed (4:1 ratio)

11 Work platform min.2 planks wide

12 Plank extended minimum 6inches

13 valid tag provided

14
wheels blocked or locked (Mobile
Scaffold)
15 Bracing has been installed

16 Rung distances 12 to 18 inches

17 Based plate provided (5'' x 5'')

18
Base lift is provide at 6'' height from
ground .

Daily Inspection by:

Approved by :_______________________