Temporary Scaffold Safety Check Application Form
Please fill out the form to document the safety check of the temporary scaffold.
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Scaffold
*
Inspector's Full Name
*
First Name
Last Name
Condition of Scaffold
*
Option 1
Option 2
Option 3
Are all safety measures in place?
*
Option 1
Option 2
Option 3
Comments or Observations
Inspector's Signature
*
Submit
Should be Empty: