Permit Request • CampusOptics

This form must be completed for all scaffolds used on University property.

IMPORTANT: Scaffolds MUST receive a RED tag if any item fails inspection.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

Scaffold Pre-Use

Project:* Required

Type of work:* Required

Company using scaffolding:* Required

Has this work location been examined before the start of work operations and have all the appropriate precautions been taken? e.g. checking for: overhead objects, falling or tripping hazards, uneven ground, opening onto a door. * Required

Will fall protection be required when using this scaffold?* Required

Has the scaffold been setup according to manufacturer’s instructions?* Required

Additional Comments

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files