Title Page
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Project Name
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Location
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Contractor
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Prepared by.
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Select date
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1<br>Have all excavation work been subject to a risk assessment before commencement, or whenever there is a change that may cause new hazards, with particular attention being paid to:<br> possibility of the fall or dislodgement of earth/rock or other materials?<br> instability of the excavation or adjoining structure?<br> in rush of water (or any other substance, e.g. sewage)?<br> placement of excavated material?<br> instability due to person or plant working adjacent to the excavation?
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2<br>Has a SWMS been developed and all excavation workers trained on its contents?
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3<br>Is an adequate system of safety (including benching, battering, shoring, or other forms of earth retention) being used to control the major hazards associated with excavations?
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4<br>If benched or battered, is the angle of repose less than 45°? (If the angle of repose is greater than 45°, written certification by a geotechnical engineer is required)
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5<br>Have trench covers and shoring been approved by a structural engineer?
6 Are excavations in or adjacent to roads adequately shored or supported to:
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Ensure the stability of residual road slab after excavation is complete?
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Provide support for all pavements or road surfaces whilst the excavation is open?
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Control for instability due to adjacent or overhead traffic?
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7<br>Have underground and overhead services been identified, marked, and located prior to excavation commencing?
8 Has a competent person been appointed to supervise:
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Excavations more than 1.5 metre deep?
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Work in tunnels?
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On caissons and cofferdams?
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Compressed air work in an excavation?
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9<br>Are all excavations been secured and barricaded to ensure the safety of persons on site and members of the public?
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10<br>Has safe access and egress been provided for in the excavation (including to and from caissons and cofferdams) throughout the duration of the works?
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11<br>Is there a procedure to ensure no person work alone in or around an excavation ranked as a high or medium risk at any time?
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12<br>If a stand by person has been provided, are they located outside the zone of influence?
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13<br>Have emergency procedures been developed and communicated to all persons working in or near the excavation works before work commences?
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14<br>Do the emergency procedures address all foreseeable major hazards, in particular:<br> collapse of excavation,<br> unplanned contact with underground or overhead services,<br> inrush of water or other substance into excavation,<br> exposure to hazardous substances?
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15<br>Has a schedule of inspections by a competent person based on the outcomes of the risk assessment been developed?
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16<br>Has a competent person completed regular inspections of the excavation as required by inspection schedule?
17 Is the zone of influence free of:
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Excavated material?
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Operating plant?
18 Have foreseeable hazards arising from the operation of plant/equipment in or near the excavation been assessed, including the following:
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Do portable ladders have a local identtifying number legibly painted on both sides?
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Contact with overhead utilities?
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Effect of mobile plant on the stability of the excavation?
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Contact with persons or other machinery?
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Ejection of material?
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Possibility of overturning?
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19<br>Has the possibility of the excavation becoming a confined space been considered and controlled?
Compliance and Follow-up Actions
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Is the activity Compliant
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Surveillance Officer
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NCPN or Memo Number
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Follow-up Action
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Product Non Conformance
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System non conformance
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Contractor generated NCR
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Contractor generated CAR
Matters Arising
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NCPN
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Contractors NCR Number
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CAR Number
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Closed out
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Representative's Name