Scaffold Hand Over Certificate

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This field is for validation purposes and should be left unchanged.

Client*

Client name*

Address Line 1*

Address Line 2

County*

Post Code*

Date scaffold erected*

Time*

:

Scaffold specification

Scaffold type*

Description*

Maximum loading*

Method of tying*

Have the ties been tested?*

Method of cladding*

Handover

This scaffold has been erected in accordance with working at height regulations 2005. It is both suitable and safe for its intended use.

The scaffold must be inspected before use, and there after regular inspections must be made, not exceeding 7 days. Any inspection must be carried out by a competent person and the results recorded. See working at height regulations for full guidelines. No changes or modifications can be made by anyone other than the scaffolder that erected the scaffold at any time during its use. If any observations are made by the hirer that gives them reason for concern whilst using the scaffold, they must exit the scaffold and contact the scaffolder immediately for advice and a resolution.

Details of any further action considered necessary:

Photo/video upload

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Acceptance

We accept that the scaffold must be inspected by a competent person from Conxim at intervals not exceeding seven days and after any event that may affect its adequacy. We (the client) will not modify the scaffold without authorisation by Conxim and the scaffold will be used within the parameters set out within this document.

Acceptance on behalf of Conxim

Name of Conxim employee*

Signature of Conxim employee*

Position of Conxim employee*

Date signed — Conxim*

Acceptance on behalf of the Client

Name of Client

Signature of client

Position of client

Date signed — Client