Information
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Site conducted
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Document No.
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Project Name
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Project Number
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Conducted on
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Prepared by
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Location
What is the name of the competent person?
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Weather
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Describe the weather conditions.
- Clear
- Rain
- Snow
- Ice
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Comments
Purpose of excavation/trench
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What is the purpose of the excavation/trench?
- Drainage
- Sewer
- Water
- Gas
- Other
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Have all the utilities been notified? (call 811)
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Comments
What are the dimensions of the excavation/trench?
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Comments
Soil Type
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Has the soil been tested?
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Who or what organization performed the soil test?
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What type of soil classification resulted from the test
- Solid rock
- Average soil
- Fill material
- Loose sand
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Comments
Protection Methods
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What type of protection method was used
- Shoring
- Trench Box
- Sloping
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Add job site photo here:
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Comments
Hazardous Conditions
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Is there surface drainage?
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Is the excavation/trench below the water table?
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Is there anything causing vibration near the excavation/trench?
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Are the spoil piles at least 2 feet from the edge of the trench .
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Is there a means of access & egress within 25 feet of safe travel?
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Does the ladder extend at least 3 feet above the landing?
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Is there any other construction activities near the excavation/trench?
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Is the excavation/trench safe to enter?
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Are there any hazardous atmospheres?
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Add extra photos here:
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Comments
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Competent Person Signature