Title Page

  • Conducted on

DETAILS

  • Client / Site: Barwon Water - Black Rock WRP Inlet Works Upgrade 400 Black Rock Connewarre

  • Inspection Area:

  • Works Description:

  • Excavation Permit Number

  • Document No. HSE-CS-001 ITP No:

WEATHER

  • Rain

  • Notes/Comments

  • Ambient conditions

  • Notes/Comments

SURFACE CONDITIONS

  • No surface cracks<br>

  • Spoil away from edge (1mt) & away from protected vegetation

  • Plant/ Equipment/ Materials away from edge

  • Vibration sources

  • Barricading in place - soft barrier 2 my from edge

  • Lighting in place

  • Walkways and Bridges

SLOPING, BENCHING, OR SHORING

  • Benching - max 1mt vertical wall ( min 1mt horizontal)

  • Battering - max 1:1 ratio slope

  • Shoring - max 1mt unsupported wall below shield

EXCAVATION

  • Adequate access/ egress for employees & fauna

  • Stairs, ladders and Ramps

  • Dewatering / No standing water

  • Build up of gasses

COMPLIANCE WITH PERMITS, PROCEDURES AND JOB REQUIREMENTS

  • Excavation and Trench Permit

  • Dial Before you Dig/ Services marked

  • Safe Work Method Statement

  • Isolation, Lock Out / Tag Out

APPROVALS

  • Other Comments

  • Person Completing the Checklist

  • Signature:

  • Agfab Approval By:

  • Signature:

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