P. O. Box: 261032, Dubai, U.A.E Tel: 04 – 2821182, Fax: 04 - 2820215 E-mail: dynatechsafety@eim.ae

SCAFFOLD HANDING / TAKING OVER REPORTProject : Supplier :

Job No.: Inspector :

Date : Ref. No. :

DETAILS OF SCAFFOLD ERECTED

Type of Scaffold

Size of base lift

No. Of intermediate lifts

No. Of working lifts

Type of working platform

Guard rail provided Yes / No

Toe board provided Yes / No

Ties and braces provided Yes / No

Ladders provided Yes / No

Copy of instruction sheet for operation / maintenancehanded over to the site staff Yes / No

Handed over by -

Signature Name Date

ACCEPTANCE -

Safe to work

Unsafe to work for the reasons marked in the check list.

Signature Name Date

Format # DSSS/S/07