Scaffold Handover Certificate

Scaffold Handover Certificate
Document the official handover and acceptance of scaffolding for safe use on site.
Project Name
Site Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Scaffold Location/Area
Scaffold Type/Specification
Date of Inspection and Handover
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Name of Scaffold Erector/Contractor
First NameLast Name
Name of Inspector
First NameLast Name
Inspection Findings
Rows Pass Fail Comments
Guardrails installed
Platforms secured and complete
Access ladders provided
Toe boards in place
Scaffold stability checked
No visible defects
Are there any restrictions or special instructions for scaffold use?
If yes, please specify restrictions or special instructions
Name of Person Accepting Scaffold (Receiver)
First NameLast Name
Contact Phone Number of Receiver
Please enter a valid phone number.Format: (000) 000-0000.
Signature of Receiver
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Rows	Pass	Fail	Comments
Guardrails installed
Platforms secured and complete
Access ladders provided
Toe boards in place
Scaffold stability checked
No visible defects