Mobile Scaffold Assembly Verification Form
Project Name
Location
Date
Scaffold Tag Number
Person Assembling Scaffold
Competent Person Verification
Scaffold Assembly Checklist
Base plates or castors installed and locked
Scaffold is plumb and level
Bracing installed correctly and secure
Safe access provided (ladder or stairs)
Platform boards fully decked and secure
Guardrails and toe boards installed
Outriggers/falling prevention measures used as required
Safe working load clearly stated
Scaffold free from defects
Work area around scaffold is clear
Comments/Notes
Assembled by (Name & Signature)
Date
Verified by (Name & Signature)
Date