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10. Protocol and checklist for periodic inspections
We hereby confirm that the work has been carried out in its entirety and in accordance with the
corresponding documentation and that the work platform is free of defects. All relevant specifications,
regulations, standards and safety provisions have been complied with. The current inspection plate has been
affixed.
Company:
Town/City:
1
Remarks:
Company:
Town/City:
2
Remarks:
Company:
Town/City:
3
Remarks:
Company:
Town/City:
4
Remarks:
Company:
Town/City:
5
Remarks:
Periodic inspections, maintenance/repairs
Date:
Date:
Date:
Date:
Date:
Competent person:
Signature:
Competent person:
Signature:
Competent person:
Signature:
Competent person:
Signature:
Competent person:
Signature:
EN
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