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Stilt Daily Inspection Form

Jobsite :

Jobsite 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 ****