Scaffold Handover Certificate Example
Example document for Scaffold Handover Certificate. Use this as a reference when creating your own.
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Document: Scaffold Handover Certificate
Example Document
Last updated 7/30/2026
SCAFFOLD HANDOVER CERTIFICATE
Project Details Project Name: West End Apartments Build Site Address: 123 Smith Street, Brisbane QLD 4000 Client / Principal Contractor: BuildCo QLD Pty Ltd Date of Handover: 15/10/2023
Scaffolding Contractor Details Company Name: SkyHigh Scaffolding Solutions ABN: 12 345 678 901 Contact Person: John Smith Phone Number: 07 1234 5678
Scaffold Details Scaffold ID / Tag Number: SF-BNE-055 Type of Scaffold: Modular System Scaffold Maximum Height: 12.5m Maximum Load Capacity: 2.0 kPa (Light Duty) Duty Class: Light Specific Exclusions: No storage of bricks or concrete blocks. No loading of heavy machinery on decks.
Declaration I, John Smith, holding High Risk Work License LA123456, certify that:
- The scaffold listed above has been erected in accordance with the relevant Australian Standards (AS 1576).
- The scaffold has been inspected and tested for structural integrity and stability.
- All necessary guardrails, toe boards, and access points are in place.
- The scaffold is safe to use for the intended purpose stated above.
Scaffolder Signature: J. Smith Date: 15/10/2023
Acknowledgment of Receipt I, Sarah Jones, acknowledge receipt of this scaffold. I understand the load limitations and the conditions of use. I accept responsibility for the control and maintenance of the scaffold until it is dismantled or returned.
Receiver Signature: S. Jones Position: Site Supervisor Date: 15/10/2023
Next Inspection Due: 15/11/2023
Notes
This example shows a completed form for a light duty scaffold in Queensland. Note the specific exclusion regarding brick storage, which is for compliance with the load rating.
About this Example
Part of the Scaffold Handover Certificate document collection
Document Type
Scaffold Handover Certificate
A record confirming a scaffold structure is safe for use and has been handed over from the contractor to the site principal or user.