Title Page

  • Project Name

  • Location

  • Contractor

  • Prepared by.

  • Select date

  • 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?

  • 2<br>Has a SWMS been developed and all excavation workers trained on its contents?

  • 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?

  • 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)

  • 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:

  •  Ensure the stability of residual road slab after excavation is complete?

  •  Provide support for all pavements or road surfaces whilst the excavation is open?

  •  Control for instability due to adjacent or overhead traffic?

  • 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:

  •  Excavations more than 1.5 metre deep?

  •  Work in tunnels?

  •  On caissons and cofferdams?

  •  Compressed air work in an excavation?

  • 9<br>Are all excavations been secured and barricaded to ensure the safety of persons on site and members of the public?

  • 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?

  • 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?

  • 12<br>If a stand by person has been provided, are they located outside the zone of influence?

  • 13<br>Have emergency procedures been developed and communicated to all persons working in or near the excavation works before work commences?

  • 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?

  • 15<br>Has a schedule of inspections by a competent person based on the outcomes of the risk assessment been developed?

  • 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:

  •  Excavated material?

  •  Operating plant?

18 Have foreseeable hazards arising from the operation of plant/equipment in or near the excavation been assessed, including the following:

  • Do portable ladders have a local identtifying number legibly painted on both sides?

  •  Contact with overhead utilities?

  •  Effect of mobile plant on the stability of the excavation?

  •  Contact with persons or other machinery?

  •  Ejection of material?

  •  Possibility of overturning?

  • 19<br>Has the possibility of the excavation becoming a confined space been considered and controlled?

Compliance and Follow-up Actions

  • Is the activity Compliant

  • Surveillance Officer

  • NCPN or Memo Number

  • Follow-up Action

  • Product Non Conformance

  • System non conformance

  • Contractor generated NCR

  • Contractor generated CAR

Matters Arising

  • NCPN

  • Contractors NCR Number

  • CAR Number

  • Closed out

  • Representative's Name

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