Scaffold Tie Testing Form
Document and assess scaffold tie inspection and testing results for site safety compliance.
Project/Site Name
*
Location of Scaffold Tie (e.g., building side, floor, bay)
*
Date of Inspection/Test
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Scaffold Type
*
Please Select
Tube and Fitting
System Scaffold
Other
Tie Reference/ID Number
*
Type of Tie
*
Please Select
Through Tie
Box Tie
Lip Tie
Other
Test Method Used
*
Please Select
Pull Test
Shear Test
Visual Inspection
Other
Test Load Applied (kN)
*
Test Result
*
Pass
Fail
Corrective Action Required (if any)
Inspector/Tester Name
*
First Name
Last Name
Inspector/Tester Signature
*
Submit Test Record
Submit Test Record
Should be Empty: