SCAFFOLD HANDOVER CERTIFICATE

Project Details Project Name: [PROJECT NAME] Site Address: [SITE ADDRESS] Client / Principal Contractor: [CLIENT NAME] Date of Handover: [DD/MM/YYYY]

Scaffolding Contractor Details Company Name: [SCAFFOLD COMPANY NAME] ABN: [SCAFFOLD ABN] Contact Person: [CONTACT NAME] Phone Number: [PHONE NUMBER]

Scaffold Details Scaffold ID / Tag Number: [TAG NUMBER] Type of Scaffold: [e.g. Tube and Coupler, System, Mobile] Maximum Height: [HEIGHT IN METRES]m Maximum Load Capacity: [LOAD LIMIT] kPa Duty Class: [LIGHT, MEDIUM, or HEavy] Specific Exclusions: [LIST ANY EXCLUSIONS, e.g. No cantilever loads]

Declaration I, [NAME OF SCAFFOLDER/COMPETENT PERSON], holding [LICENSE NUMBER IF APPLICABLE], certify that:

1. The scaffold listed above has been erected in accordance with the relevant Australian Standards (AS 1576).
2. The scaffold has been inspected and tested for structural integrity and stability.
3. All necessary guardrails, toe boards, and access points are in place.
4. The scaffold is safe to use for the intended purpose stated above.

Scaffolder Signature: __________________________ Date: __________________________

Acknowledgment of Receipt I, [NAME OF SITE RECEIVER], 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: __________________________ Position: __________________________ Date: __________________________

Next Inspection Due: [DD/MM/YYYY OR AS REQUIRED BY REGULATIONS]