Scaffold risk assessment and method statement checklist
On-site assessment
What does this form include?
This form contains 33 sections:
Generic Risk
- Unknown Site Hazards
- Competence, Supervision & Information
- Contact With Delivery/Collection Vehicles
- Manual Handling During Unloading/Loading and During Movement of Materials on Site
- Abrasion, Splinters from Handling Scaffold Boards, Lubricant from Handling Scaffold Fittings
- Trips and Slips Over our Materials Whilst Being Stored on Site or Whilst Being Used During Erection/Dismantle
- Fall of Materials During Movement on Site and During Erection and Dismantle
- Fall of Persons During Erection and Dismantle
- Collapse of Scaffold During Erection and Dismantle
- Access to Scaffold During Erection, Prior to Formal Inspection, Handover and During Dismantle
- Collapse of Scaffold When Erected
- Environmental Conditions (Wind, Rain, etc.)
Site Specific Risk
- Contact With Scaffold When Erected
- Contact With Electricity
- Substances Hazardous to Health
On-Site Risk Identified
Photo of Hazard
Other Risk 1
Other Risk 2
Other Risk 3
Type of Scaffold
Method Statement - Scope of Work
- Does the Scaffold Require a Design?
Design Drawing Reference Number
Location of Scaffold
Board Configuration
Number of Lifts Boarded as per SANS 10085
Bay Lengths
Lift Heights
Loading - This is not to be exceeded under any circumstances.
All Scaffold to be erected to SANS 10085?
Programme Start Date Date
Site Agent - A. Horsley HSEC Manager - S. Jansen van VuurenSenior Foreman - T. Jordao
Scaffolding tubing and couplers to be fit for use as prescribed by SANS 10085.All the above will be i
Standard Equipment is:- Safety Footwear, Safety Helmet, Safety Harnesses, high visibility vests and g
Work areas will be segregated by mean of physical barrier with signs designating such.Materials will
The contractor will comply with Clients site emergency procedures.The contractor to supply on-site fi
All Scaffolding materials will be removed from site upon completion of works.Any substances that are
Users of scaffold are directly responsible for ensuring that the scaffold is only used for its intend
Work Method / ProcedureErect tube and fitting Independent scaffolding as per SANS 10085 and site requ
Monitoring and complianceWorking Foreman will ensure that this Method Statement is adhered to by mean
I confirm that I have been instructed on the method of work, hazards and risks involved and the neces
Handover ProcedureFollowing completion of the scaffold a suitably qualified inspector will carry out
If contracted to do so, S&K will carry out statutory inspections in accordance with the Work at heigh
Handover Procedure
- The client or its Agent to carry out inspections?
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