Name
Signature
Date, Time
Remarks
Installation location
Position
Client
Scaffolder
Date
Signature
Working scaffold according to
EN 12811, for Load Class
1-2: maintenance work 1.50 kN/m
2
3: paint/plaster work 2.00 kN/m
2
4-6: brickwork ≥ 2.00 kN/m
2
Width Class W
W06 0.6 ≤ w ≤ 0.9 m
W06 0.9 ≤ w ≤ 1.2 m
W12-W24 w ≥ 1.2 m
kN/m
2
To be completed by the supervisor
To be completed by the inspecting person
Assembly Certificate
Handing-Over Certificate
© 2007 PERI GmbH All Rights Reserved 113834
Any modifications made to the
scaffold, e.g. removal of anchors,
may only be carried out by the
scaffolder.
Date Time Signature
Date:
Scaffold is no longer
authorized for use:
Inspection by qualified person only
Important
Inspection Record
12
Safety instructions
In carrying out required work, the
following signs are to be observed:
If certain parts of the scaffolding are
not ready for use - especially during as-
sembly, modification work and disman-
tling - a “No Entry” warning sign re-
stricting access must be clearly
displayed (see Sign 1).
In addition, the area must be adequate-
ly closed off in order to prevent access
to these parts.
Identification markings
Laws and regulations
Sign 1 Sign 2 Sign 2, rear side
After assembly has been complet-
ed, all scaffold entry points must
clearly display the designated sign.
(Sign 2)
The signs do not replace the inspec-
tion record! (Sign 2, rear side)
– In Germany, during the assembly, modification and dismantling as well as the
use of the scaffolding, accident prevention regulations and guidelines of the
employer’s liability insurance associations along with national health and safety
regulations must be taken into account, in particular:
– Product Safety Act (ProdSG)
– Guideline 2009/104/EC
– Operating Safety Regulation (BetrSichV)
– Statutory Accident Insurance (DGUV) Information 201-011
– BGV A1
– TRBS 2121
– TRBS 1203
– Regulations for Occupational Health and Safety on Construction Sites 30 (RAB 30)
The latest version in each case is applicable.
In other countries, ensure that the
relevant national guidelines and
regulations in the respective cur-
rent version are complied with!
PERI UP Flex Reinforcement Scaffold 75 and 100
Instructions for Assembly and Use – Standard Configuration
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