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Stilt Daily Inspection Form
Jobsite :
All Jobsites
Allergan Build Out
BNYM - 6th Floor
NJEDA - Department of Health Building
Verizon Wall Expansion
Jobsite Area :
Select Area
Week Date: *
Fecha de la semana:*
Subcontractor: *
Subcontratista:*
Inspector:*
Fecha de la semana:*
Model & Identification #:*
Modelo e identificación #*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Inspection Topics:
Pass Fail
Pass Fail
Pass Fail
Pass Fail
Pass Fail
Pass Fail
Pass Fail
Floors Clear of all material
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Floors Swept
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Barricades/Signs installed
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Stilt Inspected
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Stilt bolts tight
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Stilt footbed wear inspected
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Stilt footbed wear inspected
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Spotter designated
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Scaffold for stilt operator
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Overhead inspection
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
JHA/PTP Reviewed
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Identify work/
Column areas
Overall Assessment
Inspector Initials:
Safety Supervisor Signoff
clear signature
clear signature
clear signature
clear signature
clear signature
clear signature
clear signature
****NOTE: If inspection faills any of the following topics get with foreman immediatly ****
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