Title Page
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Conducted on
DETAILS
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Client / Site: Barwon Water - Black Rock WRP Inlet Works Upgrade 400 Black Rock Connewarre
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Inspection Area:
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Works Description:
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Excavation Permit Number
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Document No. HSE-CS-001 ITP No:
WEATHER
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Rain
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Notes/Comments
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Ambient conditions
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Notes/Comments
SURFACE CONDITIONS
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No surface cracks<br>
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Spoil away from edge (1mt) & away from protected vegetation
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Plant/ Equipment/ Materials away from edge
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Vibration sources
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Barricading in place - soft barrier 2 my from edge
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Lighting in place
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Walkways and Bridges
SLOPING, BENCHING, OR SHORING
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Benching - max 1mt vertical wall ( min 1mt horizontal)
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Battering - max 1:1 ratio slope
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Shoring - max 1mt unsupported wall below shield
EXCAVATION
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Adequate access/ egress for employees & fauna
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Stairs, ladders and Ramps
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Dewatering / No standing water
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Build up of gasses
COMPLIANCE WITH PERMITS, PROCEDURES AND JOB REQUIREMENTS
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Excavation and Trench Permit
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Dial Before you Dig/ Services marked
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Safe Work Method Statement
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Isolation, Lock Out / Tag Out
APPROVALS
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Other Comments
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Person Completing the Checklist
- Greg Grima
- John Toner
- Shane Dando
- David Howard
- Greg Oman
- Ian McCormick
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Signature:
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Agfab Approval By:
- Greg Grima
- John Toner
- Shane Dando
- David Howard
- Greg Oman
- Ian McCormick
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Signature: