CERTIFICATE OF SCAFFOLD
We, Gulf Test Safety Consultancies, Dubai, certify that the below particulars are correct and Scaffold described herein
is inspected by a competent person, according to the regulations of Dubai Local Order 61/1991, BS EN 12811-1, 2,3 –
Scaffolds, BS 2482:2009 - Specification for timber scaffold boards, BS EN 74-1:2022, BS EN 74-2:2022, BS EN
74-3:2007 Couplers, spigot pins and base plates, OSHA Standards – 29 CFR 1926 Subpart L. The Scaffold has
been found to be free from any adverse qualities that can affect its safe use. Please refer detailed report overleaf.
Job No:
Certificate No:
NAME & ADDRESS OF THE OWNER
INSPECTION REQUESTED BY
LOCATION
DESCRIPTION
TYPE
REFERENCE DETAILS
INTENDED USE OF SCAFFOLD
PLATFORM DETAILS
NUMBER OF WORKING DECKS
SCAFFOLD HEIGHT & TOP WORKING
PLATFORM HEIGHT
DUTY CLASSIFICATION
SAFE WORKING LOAD.
TEST LOAD APPLIED
TYPE OF INSPECTION
TEST EQUIPMENTS USED
DATE OF PREVIOUS INSPECTION
DATE OF INSPECTION
CERTIFICATE VALIDITY
NOTE: The validity of the certificate ceases in the event that any repair or alteration made, in which case it must be retested.
The inspection certificate/report shall not be reproduced except in full without the approval of the inspection body and the client.
(Signature …….) (Signature …….)
Inspected By: Name:
Designation: Designation:
Authorized Signatory
The certificate is issued subject to the condition that is understood and agreed that nothing in the report shall be deemed to relieve any designer, manufacturer,
seller, supplier, repairer or operator of any warranty, expressed or implied, and Gulf Test Safety Consultancies shall be limited to the acts or omission of its
employees, agents and subcontractors. Under no circumstance whatsoever shall Gulf Test Safety Consultancies be liable for any injury or damage to any person, or
occurring by reason of negligent operation or any defect in materials, machinery, equipment or other items other than such defects ascertainable by normally
accepted testing standards and those items inspected by Gulf Test Safety Consultancies and which are covered by this certificate.
GTS-CERT-24.REV.04
PAGE 01 OF 02
Certificate No: Job Order No:
COMPONENTS Remarks
Scaffold ID no.
Safety marking - site safety, barricade, warning notices, housekeeping
Ground conditions - loose soil, wet soil, concrete, mosaic, asphalt, near to river
Scaffold component condition – bend, rust, crack, deformation
Nearby activities / Hazards – cranes, excavation
Sole board- 38mm tk, 250 mm wide
Base plate – 150 mm wide, 6mm tk
Screw jack – check threads, bent
Standard spacing – bay length
Foot tie, as close as possible
Level
First lift height max 2.7 m
Ledger spacing, 2m
Minimum clear height at shoulder level, 1.6m
Brace, zigzag, cross
Brace angle, 35-55 deg
Main transom
Intermediate transom
No. of planks/ Boards
Length of platform in m
Front edge of all platforms from the face of the work, 14 inches
Toe board, 6 inches/ 150mm
Spacing between platform and toe board, 6mm
Application for personnel only, 3boards/ 600mm
Application for personnel and materials, 4 boards/ 800mm
Coupler fittings, cracks, tightness, appropriately used
Hand rail/ Guard rail, 0.95-1.0 m
Mid rail, 0.47 m
Plank overhang, 6-12 inches max
Plank overlapping, 12 inch
Plank tying, brc clamps
Safe access - Ladder
Access opening – 450 mm wide
Fall protection
Ladder condition
Ladder tying / clamps / 8mm wires nylon
Ladder inclination, 4:1, 75 deg
Paints, cracks in ladder
Ladder extension above platform level, 1m
Ties
Rakers, angle not greater than 75 deg
Scaffold Inspection should be carried out once in a week by competent person.
CRITICAL FINDINGS & TARGET DATE – NIL
FINDINGS & TARGET DATE
GTS-CERT-24 REV.04 PAGE 02 OF 02
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Gulf Test Safety Consultancies, P.O. Box: 184518, Dubai, U.A.E. Tel: 04-2734038, Fax: 04-2734039
