Scaffold Incident Report
Document Control Company: [COMPANY NAME] · Logo: [COMPANY LOGO] · Address: [COMPANY ADDRESS] Prepared by: [RESPONSIBLE PERSON] · Date: [DATE] · Approved by (signature): _________________
| Field | Value |
|---|---|
| Category | Scaffolding |
| Recommended Industry | All |
| Document Type | Report |
| Access Level | Starter |
| Last Reviewed | 2026-06-29 |
| Last Updated | 2026-06-29 |
How to Use This Template
Complete the fields as fully and accurately as possible at the time of the task or event. Route the completed document per your internal process and retain it with your records.
Template Body
Document a scaffold-related incident or near miss (also complete the company Incident Report Form).
| Field | Entry |
|---|---|
| Date / time: | [____] |
| Location / scaffold ID: | [____] |
| Person(s) involved: | [____] |
| What happened: | [____] |
| Scaffold condition / tag status at the time: | [____] |
| Contributing factors: | [____] |
| Injuries / damage: | [____] |
| Immediate actions: | [____] |
| Corrective actions: | [____] |