Please use this form if you have seen an unsafe scaffolding structure. The SAQ will receive and follow up on your reporting of unsafe scaffolding.

Please provide as much detail as you can using the fields below.

Potential Hazard: (tick appropriate from the list below)


Insufficient or non-existent Edge protection installed by PCBU/Builder.Scaffold missing Edge protection, or not compliant.Hop up components missing or not compliant.Scaffold erection/Dismantle system of work unsafe.

Containment screening missing or not compliant.Kickboards missing or not compliant.Scaffold containment screening height insufficient for the construction stage.

Bracing missing or not compliant.Ties missing or not compliant.Scaffold components missing or not compliant.Mix and matched scaffold components.Condition of equipment/ Damaged or rusted out components.




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The information supplied will remain confidential between the SAQ and the above signed.

Please note: If you have seen a scaffold structure that you consider has a risk potential for serious injury, please report this immediately to the PCBU/Builder/Workers on site, then report to the SAQ secondly.

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