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Home
Vehicle Inspection Check In
Labour Hire Docket
SWMS
Job Safety Analysis (JSA)
JSA – Roof Rail
JSA – Scaffolding
Scaff Tags
Handover Certificates
Scaffolding Handover Certificate
Roof Rail Handover Certificate
Reporting page
Safety Meeting/Toolbox Record
Upload Job Photos
Management
Employee Forms
Timesheets
Employee Self Evaluation Form
Application for Leave
Company Policies and Employment Documents
Scaffold Observation checklist
Step
1
of
13
7%
General housekeeping
Person being observed:
Full Name
Date
DD slash MM slash YYYY
Has the employee read, understood, and signd onto the SWMS 3 (Scaffolding)?
If no is ticked do not proceed - all workers must be signed onto the SWMS before commencing work.
Yes
No
Has the employee been inducted onto site (if applicable) and have they signed in?
Yes
No
Not applicable
Site Requirements
Does the employee know where the first aid bag is and where the emergency muster point is?
Yes
No
Advise/Comment
Further comment
Is correct PPE being worn for the site requirements (minimum requirement includes high-vis shirt, gloves, steel capped boots and hard hat)?
Yes
No
Advise/Comment
Further comment
Risk/Hazard identification & control
Is the employee able to carry out a pre-start JSA (based from the SWMS) correctly, and accurately identify hazards found onsite including but not limited to "Live Power"
Yes
No
Advise/comment
Further comment
Is the employee able to identify control measures for these hazards?
Yes
No
Advise/Comment
Further comment
Knowledge & Understanding
Has the employee discussed the scaffold requirements with the foreman onsite?
Yes
No
Advise/Comment
Further comment
Is the employee able to read, understand and advise his team members the plans for the installation of the scaffold?
Yes
No
Advise/Comment
Further comment
Has the employee clearly set out each of their team members their duties & responsibilities for the job?
Yes
No
Advise/Comment
Further comment
Has the Employee created an exclusion zone from other workers prior to starting any of their scaffolding works?
Yes
No
Advise/Comment
Further comment
Does the employee understand the purpose in which they are building the scaffold for and what trades are to be utilising it along with the maximum duty load – Light 225kg, Medium 450kg or Heavy 675kg?
Yes
No
Advise/Comment
Further comment
Is the employee competent in the safe layout of the build of the scaffolding ensuring they are not leaning equipment up in an unsafe manner and or laying down where this could create trip hazards to other workers?
Yes
No
Advise/Comment
Further comment
Does the employee understand the correct methodology to base the scaffolding out and correct distances from the wall or internal side of the scaffold (maximum 225mm)?
Yes
No
Advise/Comment
Further comment
Are all jacks and sole boards squarely set level with the jack in the centre of the sole board?
Yes
No
Advise/Comment
Further comment
Does the employee continue to communicate to his team members that they are laying out the correct gear for the second lift of the scaffold?
Yes
No
Advise/Comment
Further comment
Are ALL scaffold components being installed correctly with ALL items as per design and as it is continuously built including Screw Jacks/Sole Boards, Standards, Ledgers, Transoms, Boards, braces, access (ladder or stair) ties and or buttress bays?
Yes
No
Advise/Comment
Further comment
Are internal handrails being installed on any “Live Edge” of the scaffold?
Yes
No
Advise/Comment
Further comment
Once installing the second lift and onto further lifts is the employee working within the 1m lift rule via planks or platform ladder completing all decks levels 100% before moving to the next?
Yes
No
Advise/Comment
Further comment
Are all lap boards lashed down where required using double twisted tie wire?
Yes
No
Advise/Comment
Further comment
Upon completion and prior to handover has the Employee walked the entirety of the scaffold ensuring the scaffold is complete and ready to handover (With the client if possible)?
Yes
No
Advise/Comment
Further comment
Have all excess components been tidied up, congested and placed in a safe and secure place ready for pick up if required?
Yes
No
Advise/Comment
Further comment
Has the Scaffold Tag been completed correctly including date of install & duty rating?
Yes
No
Advise/Comment
Further comment
Has the handover certificate been completed correctly including ALL required items?
Yes
No
Advise/Comment
Further comment
Knowledge Test
What is the Maximum legal distance a scaffold can sit off a wall or structure? What is to happen if the gap exceeds the maximum distance?
Answer: 225mm, Internal handrail or Block off scaffold with transom AND danger tape.
Correct
Wrong
Advise/Comment
Further comment
What is the first step each day for a Scaffolder/Labourer, before the prestart JSA is completed?
Answer: Read the plan, gain an understanding of the job and what the scaffold requirements are.
Correct
Wrong
Advise/Comment
Further comment
If you have equipment on top of jacks and sole boards, or face braces on top of standards and you need to reach the items underneath; what should you do with the stuff on top?
Answer: Lug/carry the items on top to where they need to be on the scaffold, do not double handle these items if there is somewhere for them to go.
Correct
Wrong
Advise/Comment
Further comment
When should a labourer help a truck driver unload?
Answer: Only if it's unsafe for the driver to unload on their own. I.e. over a pedestrian pathway, close proximity to powerlines or on a busy road.
Correct
Wrong
Advise/Comment
Further comment
When are lap boards required to be wired down?
Answer: Always.
Correct
Wrong
Advise/Comment
Further comment
When building a scaffold for a roof replacement, what height do we set the deck at and how far must the handrails go up past the gutter?
Answer: 1.0m below the roof, 1m above the roof.
Correct
Wrong
Advise/Comment
Further comment
What is the best way to lay out the base gear as a labourer/scaffolder? What is the best way to lay out the top up gear?
Answer: Lay the base gear in front of the joins where it is needed AND in a tidy position where it can be reached by the scaffolders. No gear should ever be leant up on surfaces that can be scratched or damaged such as metal fences, garage doors pr painted surfaces.
Correct
Wrong
Advise/Comment
Further comment
If there is excess gear on site after the installation of the scaffolding, what must be done with it?
Answer: Fully condense the gear into 1 stillage and move it out of the way - check with onsite contact where this location may be.
Correct
Wrong
Advise/Comment
Further comment
How many components are required for the below scaffold, intended for a new roof and cladding installation that is 1 x 2.4m long x 1.2m wide - no hop up. The scaffold is to be set at 1m & 4m below the roof with a 1m dummy underneath the top deck. Top deck sits at 6.0m high off the ground.
Answer: (Ledgers: 16)(Transoms: 5 per leg or 10 per bay)(Boards: 12)(Inside standard 3,3)(Outside standard: 3,3,2)
Correct
Wrong
Advise/Comment
Further comment
How many packs of boards/stillages can the following trucks carry? DAF, DILLY, BIG, HINOS
Answer: (DAF - 3,2,3) (BIG - 2,2,2) (Dilly - 2,2) (Hino's - 1 x pack of boards/ledgers high, small cage with jacks/sole boards/trannies/fittings at rear.)
Correct
Wrong
Advise/Comment
Further comment
Notes and advice for further improvement:
Next review due in:
Supervisor
Full Name
Signature
Worker
Full Name
Signature
Worker Email address (if copy is required)
