AGFAB Engineering EXCAVATION & TRENCH CHECKLIST (Rev 0)

• Conducted on

  Date

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

  Yes

  No

• Notes/Comments

• Ambient conditions

  Ice

  Freezing

  Other

• Notes/Comments

SURFACE CONDITIONS

• No surface cracks<br>

  Yes

  No

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

  Yes

  No

  N/A

• Plant/ Equipment/ Materials away from edge

  Yes

  No

  N/A

• Vibration sources

  Yes

  No

  N/A

• Barricading in place - soft barrier 2 my from edge

  Yes

  No

  N/A

• Lighting in place

  Yes

  No

  N/A

• Walkways and Bridges

  Safe

  At Risk

  N/A

SLOPING, BENCHING, OR SHORING

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

  Yes

  No

  N/A

• Battering - max 1:1 ratio slope

  Yes

  No

  N/A

• Shoring - max 1mt unsupported wall below shield

  Yes

  No

  N/A

EXCAVATION

• Adequate access/ egress for employees & fauna

  Yes

  No

  N/A

• Stairs, ladders and Ramps

  Safe

  At Risk

  N/A

• Dewatering / No standing water

  Safe

  At Risk

  N/A

• Build up of gasses

  Yes

  No

COMPLIANCE WITH PERMITS, PROCEDURES AND JOB REQUIREMENTS

• Excavation and Trench Permit

  Yes

  No

  N/A

• Dial Before you Dig/ Services marked

  Yes

  No

  N/A

• Safe Work Method Statement

  Yes

  No

  N/A

• Isolation, Lock Out / Tag Out

  Yes

  No

  N/A

APPROVALS

• Other Comments

• Person Completing the Checklist

  Select Greg Grima John Toner Shane Dando David Howard Greg Oman Ian McCormick

  • Greg Grima
  • John Toner
  • Shane Dando
  • David Howard
  • Greg Oman
  • Ian McCormick

• Signature:

  Sign

• Agfab Approval By:

  Select Greg Grima John Toner Shane Dando David Howard Greg Oman Ian McCormick

  • Greg Grima
  • John Toner
  • Shane Dando
  • David Howard
  • Greg Oman
  • Ian McCormick

• Signature:

  Sign