




NRL-102 NRL-103 NGYL-SP-101 NML-1 NWL-101 NYL-901-0
Danger Do Not Use Danger Released for Use Ready for Use / Inpsection Record Caution This Scaffold Keep Off Scaffold Scaffold/Jobsite/Date Erected Inspection Record Date: Inspected By: Scaffold # Jobsite
Keep Out $.79 Safety Harness Required Requestor:_____ $.79 Date Erected:
The Scaffold is being ____Yes_____No Date:_______ Erected By:
Erected,taken down Inspecition record Location:_____ Print_____________
or been found Date: _______ Erected By:_____ Loading Schedule:____
defected Competent Persons Sign._____ W/O #:_____ Light Duty: 25lbs sq.Ft.
Do Not Alter $.79 Light Duty/Med Duty/Heavy Duty Medium Duty 50lbs sq Ft.
Date:______ See Engeneers Drawings Heavy Duty 75lbs. sq Ft
Competitent Persons Competent Persons Signture See Engineres Drawings
Signature_______ Caution: Other
Comments:______ Reason For Caution Fall Protection Required
$.79 Short Ladder ____Missing Toe Board ___Yes No___ ___Missing Hand Rail Check Incomplete Items ____Self Retracting Landyards Required While Using Handrails Midrails
Ladder Toeboard/ Plattform
____Other Explain Below Other / Ladder
Inspection Record On Back Inspection Record On Back
Front & Back $.79
$.79




LBL-1-N LBL-8-N NH-101 NH-104 NH-106 NH-108
Inspection Record Scaffold No: 123456 Danger Danger Danger
Date: Inspected By Customer: Danger Do Not Use Do Not Use Do Not Use Scaffold
Peel Away Backing Customer No. Do Not Use Scaffold Under Peligro Do Not Use
$ .21 Date Built Scaffold Under Construction No Lo Use Scaffold
Ratings:__Lite__Med___Heavy Construction $1.50 $1.50 $1.50
Foreman: $1.50
_____Access Haz_____Thermal
_____Hole In Deck ___Guardrail
______________________ Other
Additional Hazards:___________
Initials_______ Date/Time_____
$.21