V OSHA SIMULATED Trenching & Excavation Safety Checklist - [R3]

• Audit Title

• Client

• Job Site Address And Job Number

• Location
  Address

• Conducted on

  Date

• Prepared by

• SITE CONTACT & PHONE NUMBER:

SPECIFIC PROJECT INFORMATION

• PROJECT INFORMATION:

• SPECIFIC AREA AUDITED:

• TYPE OF WORK IN PROGRESS:

• PERSONAL ON SITE:

• ACTIVITY:

• EQUIPMENT IN USE:

• FUTURE WORK:

• RECOMMENDATIONS:

• GENERAL NOTES:

GENERAL INSPECTION

• Has the "Competent Person" had specific training in -- and is knowledge about -- soil analysis, use of protective systems, and the requirements of 29CFR1926-Subpart P:

  Yes

  No

  N/A

• excavations over 5' in depth are shored or benched properly

  Safe

  At Risk

  N/A

• ladders provided every 25' in trenches more then 4' deep

  Safe

  At Risk

  N/A

• Are all on surface encumbrance removed or supported

  Yes

  No

  N/A

• Are all employees protected from loose rock or soil that could pose a hazard by falling or rolling into the excavation?

  Yes

  No

  N/A

• Are Hard hats and hiviz vests worn by all employees?

  Safe

  At Risk

  N/A

• Does the "Competent Person" have the authority to remove workers from the excavation immediately?

  Yes

  No

  N/A

• is eye and hearing protection worn when needed.

  Safe

  At Risk

  N/A

• Are excavations, adjacent areas, and protective systems inspected by a competent person:

  Daily prior to start of work

  As needed throughout the shift

  After every rainstorm or other occurrence that could increase the hazard

• Photos

  Media

• Are spoils, materials, and equipment set back at least 2 feet from the edge of your excavation

  Yes

  No

  N/A

• Are barriers provided at all remotely located excavations, wells, pits, shafts, etc.?

  Yes

  No

  N/A

• Are employees required to stand away from vehicles being loaded and unloaded?

  Yes

  No

  N/A

• Are warning systems established and used when mobile equipment is operating near the edge of an excavation?

  Yes

  No

  N/A

• Are employees prohibited from going under suspended loads?

  Yes

  No

  N/A

• Are employees prohibited from working on the face of slope or benched excavation above other employees?

  Yes

  No

  N/A

• Notes or concerns?

UTILITIES

• Are utilities companies contacted and/or utilities located as required by local, state, and federal law?

  Yes

  No

  N/A

• Are the exact locations clearly marked?

  Yes

  No

  N/A

• Are underground installations protected, supported, or removed when the excavation is open?

  Yes

  No

  N/A

TRENCH ACCESS & EGRESS

• Trench access to be recorded?

  Yes

  No

  N/A

• Are proper ladders or other means of access and egress in place and all trenches 4 feet or more in depth?

  Yes

  No

  N/A

• Are all employees within 25 feet of a means of access and egress?

  Yes

  No

  N/A

• Ramps [ if needed ] are properly designed, graded and compacted?

  Yes

  No

  N/A

WET CONDITIONS

• Wet conditions to be recorded?

  Yes

  No

  N/A

• Are precautions taken to protect employees from water accumulation?

  Yes

  No

  N/A

HAZARDOUS ATMOSPHERES

• Are hazardous conditions to be audited?

  Yes

  No

  N/A

• Is the atmosphere within all excavations tested when there is a reasonable possibility of an oxygen deficiency, oxygen enriched, combustible, toxic, or other harmful contaminant?

  Yes

  No

  N/A

• Are adequate precautions taken to protect employees from exposures to an atmosphere containing less then 19.5% oxygen and or other hazardous atmosphere?

  Yes

  No

  N/A

• Is verification provided to protect employees from an atmosphere containing flammable gases in excess of 10% of the lower explosive limit of the gas?

  Yes

  No

  N/A

• Is emergency equipment available when hazardous atmosphere could or do exist?

  Yes

  No

  N/A

• Are employees trained to use personal protective equipment and other rescue equipment?

  Yes

  No

  N/A

• Has the competent person classified the soil using one manual test and one visual test, as specified by the standard?

  Yes

  No

  N/A

SUPPORT SYSTEMS

• Are support systems being audited

  Yes

  No

  N/A

• Type of support system being used?

  Select none required Shoring Sloping Shielding Designed by Registered Professional Engineer

  • none required
  • Shoring
  • Sloping
  • Shielding
  • Designed by Registered Professional Engineer

• Are materials and/or equipment chosen based upon soil analysis, Trench depth and expected it loads?

  Yes

  No

  N/A

• Are materials and equipment that are used for protective systems inspected and in good condition?

  Yes

  No

  N/A

• Are damaged materials and equipment immediately removed from service?

  Yes

  No

  N/A

• Are damaged materials and equipment inspected by a registered professional engineer after repairs are made in before being placed back into service?

  Yes

  No

  N/A

• Are protective systems installed without exposing employees to hazards of cave-ins, collapses, or other threat of being struck by materials or equipment?

  Yes

  No

  N/A

• Are all members of support system securely fastened together prevent failure?

  Yes

  No

  N/A

• Are support systems provided to insure stability of adjacent structures, buildings, roadways, sidewalks, etc.?

  Yes

  No

  N/A

• Are excavation below the level of the base or footings supported, and approved by a Registered Professional Engineer?

  Yes

  No

  N/A

• Does back-filling progress with removal of the support system?

  Yes

  No

  N/A

• Is a shield system installed to prevent lateral moment?

  Yes

  No

  N/A

• Are employees prohibited from remaining in a shield system during vertical movement?

  Yes

  No

  N/A

TRAFFIC MANAGEMENT AND CONTROL.

• Is Traffic management and control being audited?

  Yes

  No

  N/A

• Lack of or inadequate traffic managment plan [TMP] in place

  Safe

  At Risk

  N/A

• Emergency contacts and procedures displayed on site or given to workers as needed

  Safe

  At Risk

  N/A

• Lack of training in TMP for all persons on site.

  Safe

  At Risk

  N/A

Emergency response

• High wind, heavy rain, extreme weather or severe storm plans in place.

  Safe

  At Risk

  N/A

VEHICLES.

• Are vehicles being audited?

  Yes

  No

  N/A

• All vehicles have unobstructed view and back up alarm is working

  Safe

  At Risk

  N/A

• ALL OPERATORS ARE PROPERLY LICENSED AND FULLY TRAINED TO USE THE EQUIPMENT

  Safe

  At Risk

  N/A

• All vehicles have seat belts or restraints and are used at all times.

  Safe

  At Risk

  N/A

• Workers kept from under suspended loads at all times.

  Safe

  At Risk

  N/A

• NOTES

ELECTRICAL HAZARDS

• Are electrical hazards being audited?

  Yes

  No

  N/A

• Unsafe electrical cords [ Damaged, pulled out of strain relief, taped or missing ground prong ] .

  Safe

  At Risk

  N/A

• GFCI'S Used at all times[GENERATORS OR SUPPLIED POWER] and tested on a regular basis

  Yes

  No

  N/A

• When operating near overhead or underground utilites is a spotter used?

  Yes

  No

  N/A

GENERAL

• Lack of "LOTO" [LOCK OUT/ TAG OUT] procedures for all equipment.

  Safe

  At Risk

  N/A

• General neatness of work area.

  Safe

  At Risk

  N/A

• Proper material storage procedures.

  Safe

  At Risk

  N/A

• Tool box talks and/or safety meetings up to date.

  Safe

  At Risk

  N/A

• FIRST AID KITS READILY AVAILABLE

  Yes

  No

  N/A

• Lack of hot weather provisions when required. [Cool drinking water etc.]

  Safe

  At Risk

  N/A

• Fire extinguisher at all gas powered equipment.

  Safe

  At Risk

  N/A

• All gas cans are approved metal safety cans, stored and used properly.

  Safe

  At Risk

  N/A

NOTES AND SIGNATURE OF AUDITOR.

• General notes:

• Add signature

  Sign